Current and emerging therapies for stroke prophylaxis in atrial fibrillation

Author(s): Eric TS Lim, Jonathan Yap, Chee Tang Chin

Atrial fibrillation (AF) increases risk of stroke fivefold. This is mainly due to cardioembolism of left atrial appendage thrombus to the cerebral circulation. Currently, the principal means of stroke prophylaxis is anticoagulation using warfarin, an oral vitamin K antagonist. However, owing to the risk of hemorrhage associated with warfarin, there is considerable interest in alternative means of stroke prophylaxis. This article summarizes the evidence that warfarin and recently developed novel oral anticoagulants (e.g., dabigatran, rivaroxaban, apixaban and tecarfarin) are effective for reducing stroke risk in AF patients. We also review the impact of newer approaches such as surgical and percutaneous left atrial appendage closure and AF-rhythm control strategies in reducing stroke risk.