How to improve anticoagulant therapy in atrial fibrillation?

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Abstract

Atrial fibrillation is the most important risk factor for stroke, and as a preventive strategy in these patients anticoagulant therapy are must be prescribed. Currently, pivotal clinical guidelines emphasize the superiority of direct oral anticoagulants (DOACs) over vitamin K antagonists. At the same time, difficult cases in clinical practice are often encountered, patients’ risk of ischemic and bleeding events may significantly change, they also may have a burden of various comorbidities, impaired renal function and/or exposed to surgical intervention. These factors make it difficult to choose the optimal anticoagulant therapy strategy and prescribe optimal DOAC. Also, due to the prevailing adverse epidemiological conditions, it is impossible to ignore the potential effects of the new coronavirus infection on patients with atrial fibrillation. In such complex clinical cases, among the DOACs, the first choice drug is apixaban, due to its extensive body of evidence (both according to randomized clinical trials and real world data), which confirms the optimal efficacy and safety balance in above mentioned patients. Key words: atrial fibrillation, direct oral anticoagulants, apixaban, clinical practice, high risk of stroke/bleeding, coronary artery disease, chronic kidney disease, surgical intervention, COVID-19. For citation: Kochetkov A.I., Ostroumova O.D., Lyakhova N.L., Butorov V.N. How to improve anticoagulant therapy in atrial fibrillation? Consilium Medicum. 2020; 22 (5): 40-48. DOI: 10.26442/20751753.2020.5.200151

About the authors

Aleksei I. Kochetkov

Russian Medical Academy of Continuous Professional Education

канд. мед. наук, доц. каф. терапии и полиморбидной патологии Moscow, Russia

Olga D. Ostroumova

Sechenov First Moscow State Medical University (Sechenov University)

Email: ostroumova.olga@mail.ru
д-р мед. наук, проф., зав. каф. терапии и полиморбидной патологии Moscow, Russia

Natalia L. Lyakhova

Botkin City Clinical Hospital

канд. мед. наук, зав. кардиологическим отд-нием для больных с острым инфарктом миокарда Moscow, Russia

Vasilii N. Butorov

Russian Medical Academy of Continuous Professional Education

канд. мед. наук, доц. каф. терапии и полиморбидной патологии Moscow, Russia

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