Anticoagulation strategies for stroke prevention in atrial fibrillation: a comprehensive review of current literature
Castro-Vidal, Zainab Aslam Gandapur, Asad Prakash, Rohit Azab, Khaled Nayyar, Khushi Rinkoo, Fnu Kommuru, Sravani Elsoussi, Youssef Bojanki, Nagavenakta Lova Surya Vamsi Avinash Yennam, Anil Kumar
Castro-Vidal, Zainab Aslam
Gandapur, Asad
Prakash, Rohit
Azab, Khaled
Nayyar, Khushi
Rinkoo, Fnu
Kommuru, Sravani
Elsoussi, Youssef
Bojanki, Nagavenakta Lova Surya Vamsi Avinash
Yennam, Anil Kumar
Affiliation
Saba University School of Medicine; University of Nebraska Medical Center; South Tees Hospitals NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; Adesh Institute of Medical Sciences and Research; Ghulam Muhammad Mahar Medical College; Dr Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation; University of Sharjah; Siddhartha Medical College; Emilio Aguinaldo College; Shaheed Suhrawardy Medical College; Liaquat National Hospital and Medical College
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Publication date
2025-05-12
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Abstract
Atrial fibrillation (AF) significantly increases stroke risk and hence requires anticoagulation for the prevention of stroke. This review discusses strategies of anticoagulation, including the paradigm shift from traditional vitamin K antagonists (VKAs), such as warfarin, to direct oral anticoagulants (DOACs): dabigatran, rivaroxaban, apixaban, and edoxaban. VKAs are effective but require regular monitoring of international normalized ratio and also pose challenges because of their drug and dietary interactions. In contrast, DOACs provide predictable pharmacokinetics, fewer interactions, and no requirement for routine monitoring, and their use is increasingly favored in clinical practice. The review puts an emphasis on the considerations that are patient-specific when choosing an anticoagulant agent, including age, renal function, and associated diseases; stroke risk or risk factors for bleeding; and it explains how tools such as the use of CHA2DS2-VASc and HAS-BLED scores can be relevant for assessing stroke and bleeding risk, respectively. Also, it is explored that the use of emerging therapies like factor XI inhibitors and combinations such as dual antiplatelet therapy with anticoagulants has the potential to provide maximum stroke prevention but fewer bleeding complications. This review evaluated the effect of reversal agents for anticoagulants that may act as a safety measure during instances of serious bleeding. In summary, AF anticoagulation has to be individually tailored based on patient characteristics and meticulous reading of clinical guidelines. As much as DOACs present a tremendous step forward in stroke prevention related to AF, future studies and emerging treatments show promise to further optimize therapeutic outcomes.
Citation
Castro-Vidal ZA, Gandapur A, Prakash R, Azab K, Nayyar K, Rinkoo F, Kommuru S, Elsoussi Y, Bojanki NLSVA, Yennam AK, Nishat SM, Motwani J. Anticoagulation strategies for stroke prevention in atrial fibrillation: a comprehensive review of current literature. Ann Med Surg (Lond). 2025 May 12;87(6):3691-3699. doi: 10.1097/MS9.0000000000003364.
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Article