Korean Circ J.  2018 Aug;48(8):665-684. 10.4070/kcj.2018.0190.

Stroke Prevention in Atrial Fibrillation: Focus on Asian Patients

• Li YG
• Lee SR
• Choi EK
• Lip GY

• KMID: 2417690
• DOI: http://doi.org/10.4070/kcj.2018.0190

Abstract

Atrial fibrillation (AF) is the most common arrhythmia conferring a fivefold increased risk of stroke. Stroke prevention is the cornerstone of management of patients with AF. Asians have a generally higher incidence of AF-related risks of stroke and bleeding (particularly intracranial bleeding), compared with non-Asians. Despite the well-documented efficacy and relative safety of oral anticoagulation for stroke prevention among Asians, the suboptimal use of oral anticoagulation remains common. The current narrative review aims to provide a summary of the available evidence on stroke prevention among patients with AF focused on the Asia region, regarding stroke and bleeding risk evaluation, the performance of oral anticoagulation, and current use of thromboprophylaxis.

Keyword

Atrial fibrillation; Stroke; Prevention; Anticoagulant agents; Asian continental ancestry group

MeSH Terms

Anticoagulants
Arrhythmias, Cardiac
Asia
Asian Continental Ancestry Group*
Atrial Fibrillation*
Hemorrhage
Humans
Incidence
Stroke*
Anticoagulants

Figure

• 

  Figure 1 Decision-making process of stroke prevention in patients with AF from Asia. The decision-making process includes stroke risk evaluation, OAC choosing and bleeding risk control. Stroke and bleeding risk re-evaluation should be made at each medical contact. AF = atrial fibrillation; CHA2DS2-VASc = congestive HF, hypertension, age ≥75 (2 points), diabetes mellitus, previous stroke/TIA (2 points), vascular disease, age 65–74, sex category (female gender); HAS-BLED = hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly; NOAC = non-vitamin K antagonist oral anticoagulant; OAC = oral anticoagulation; TTR = time in therapeutic range; VKA = vitamin K antagonist. *Including patients' preference, risk factor severity (such as blood pressure control), bleeding risk.

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