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Changing paradigms: from prevention of thromboembolic events to improved survival in patients with atrial fibrillation.

Escobar, C; Camm, AJ (2021) Changing paradigms: from prevention of thromboembolic events to improved survival in patients with atrial fibrillation. Europace, 23 (6). pp. 837-843. ISSN 1532-2092 https://doi.org/10.1093/europace/euaa324
SGUL Authors: Camm, Alan John

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Abstract

Atrial fibrillation is associated with a five-fold increase in the risk of stroke. Current guidelines recommend the use of the CHA2DS2-VASc score to stratify the risk of stroke. In addition, guidelines recommend the identification of the conditions that increase the risk of haemorrhage to be modified and thus decrease the risk of bleeding. Nevertheless, many patients with a high thromboembolic risk are prescribed antiplatelet treatment or do not receive any antithrombotic therapy. In addition, therapeutic inertia is common in anticoagulated patients taking vitamin K antagonists, and underdosing is an emerging problem with direct oral anticoagulants, probably because many physicians consider the risk of stroke and the risk of major bleeding to be equal. It is necessary to develop a new approach to risk stratification, an approach that moves from morbidity to mortality, i.e., from stratification of the risk of stroke and major bleeding to stratification of the risk of mortality associated with stroke and the risk of mortality associated with bleeding. In this article, we propose a novel risk stratification approach based on the mortality associated with stroke and bleeding, illustrated by data derived from the literature.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in EP Europace following peer review. The version of record Carlos Escobar, A John Camm, Changing paradigms: from prevention of thromboembolic events to improved survival in patients with atrial fibrillation, EP Europace, Volume 23, Issue 6, June 2021, Pages 837–843 is available online at: https://doi.org/10.1093/europace/euaa324
Keywords: Anticoagulation, Atrial fibrillation, Bleeding, Mortality, Stroke, 1103 Clinical Sciences, Cardiovascular System & Hematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Europace
ISSN: 1532-2092
Language: eng
Dates:
DateEvent
June 2021Published
22 November 2020Published Online
23 September 2020Accepted
Publisher License: Publisher's own licence
PubMed ID: 33221894
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/112660
Publisher's version: https://doi.org/10.1093/europace/euaa324

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