Anticoagulation therapy – a key aspect of stroke prevention in patients with atrial fibrillation

  In recent years an increasing proportion of patients presenting to the clinic with atrial fibrillation have had strokes, and some acute, massive cerebral infarctions and deaths have been increasing. Data show that the prevalence of atrial fibrillation is 1 to 2 percent, with greater than 6 million Europeans suffering from this type of arrhythmia; with an aging population, the prevalence of atrial fibrillation is estimated to at least double in the next 50 years, with the number of people with the disease reaching and exceeding 12 million. In the European Union and the United States, approximately 4.5 million and 2.2 million people, respectively, have AF; in the Asia-Pacific region, there are an estimated 12 million people with AF by 2014. Patients with atrial fibrillation have five times the risk of concurrent stroke as non-atrial fibrillation patients and are at increased risk of heart failure, chronic fatigue and other arrhythmias. One in five strokes is caused by such arrhythmias. Ischemic strokes due to atrial fibrillation are usually fatal and, if survived, are more likely to leave severe disability; moreover, these patients are more likely to have a recurrent stroke than strokes due to other causes. In summary, stroke complicated by atrial fibrillation is associated with a double risk of death and a 50% increase in medical costs compared to strokes not caused by atrial fibrillation. Atrial fibrillation causes blood to stagnate and coalesce into blood clots, ultimately leading to thromboembolism, which has become the number one killer in both developed and developing countries.  Recent research data show that anticoagulants can reduce the risk of stroke by more than 60%, but globally, the use of anticoagulants is much lower than expected, and about 1/3 of patients with atrial fibrillation combined with the risk of stroke are not given anticoagulant therapy. In response, countries such as Europe and the United States have released the 2010 and 2011 guidelines for the treatment of atrial fibrillation, placing more emphasis on anticoagulation in patients with atrial fibrillation, expanding the population at risk for anticoagulation in atrial fibrillation, and increasing the intensity of anticoagulation.  Currently, oral anticoagulants mainly use warfarin, and the international normalized ratio (INR) needs to be monitored regularly during treatment. In case warfarin is underdosed or causes bleeding risk.