Atrial fibrillation as a risk factor for ischemic stroke

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  • Authors: Gilyarov M.Y.1,2, Konstantinova E.V1,3
  • Affiliations:
    1. N.I.Pirogov City clinical hospital №1 of the Department of Health of Moscow
    2. I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation
    3. N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation
  • Issue: Vol 17, No 9 (2015)
  • Pages: 16-20
  • Section: Articles
  • URL: https://journals.rcsi.science/2075-1753/article/view/94317
  • ID: 94317

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Abstract

Atrial fibrillation (AF) is a common arrhythmia affecting more than 1-2% of the population increases the risk of stroke 5-7-fold. There is no significant difference in the risk of ischemic stroke among patients with the three types of AF (paroxysmal, persistent, and permanent). Oral anticoagulation clearly prevents ischemic strokes in AF patients. Warfarin, a vitamin K antagonist, was until recently the only available oral anticoagulant for stroke prevention in AF. Warfarin has limitations that have motivated development of several novel oral anticoagulants (NOACs), including apixaban, dabigatran, rivaroxaban, and edoxaban. Clinical trials demonstrate that the NOACs at least as efficacious as warfarin and were associated with lower rates of intracranial bleeding in patients with nonvalvular AF. Choosing antithrombotic treatment involves assessing the benefits of therapy versus its risks. Risk indexes, including CHA2DS2-VASc, and HAS-BLED can help determine how to treat patients with AF. Russian and European Guidelines suggest using of NOACs as an alternative to warfarin in patients with nonvalvular AF. Left atrial appendage closure device should be considered only for individuals with a high risk of stroke and a high risk of bleeding while on anticoagulant therapy. Analysis of clinical trial data and recommendations for the management of patients with AF allows to make the decision on the appointment is effective, safe and cost-effective therapy for each patient.

About the authors

M. Yu Gilyarov

N.I.Pirogov City clinical hospital №1 of the Department of Health of Moscow; I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation

д-р мед. наук, рук. Регионального сосудистого центра ГБУЗ ГКБ№1 им. Н.И.Пирогова, доц. каф. неотложной и профилактической кардиологии ИПО ГБОУ ВПО Первый МГМУ им. И.М.Сеченова 119049, Russian Federation, Moscow, Leninskii pr-t, d. 8

E. V Konstantinova

N.I.Pirogov City clinical hospital №1 of the Department of Health of Moscow; N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

Email: katekons@mail.ru
д-р мед. наук, доц. каф. факультетской терапии им. акад. А.И.Нестерова лечебного фак-та ГБОУ ВПО РНИМУ им. Н.И.Пирогова, Региональный сосудистый центр ГБУЗ ГКБ№1 им. Н.И.Пирогова 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1

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