Prevention of Thromboembolic Complications of Atrial Fibrillation: Current Aspects and Perspective

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Management of AF patients is aimed at reducing symptoms and at preventing severe complications associated with AF (stroke and thromboembolism). Stroke prevention in AF has been challenging over decades, mostly due to a number of difficulties associated with oral vitamin K antagonists (VKAs), which were the most effective stroke prevention treatment for a long time. Until recently, oral VKAs were the only available drugs for oral anticoagulation. Following the successful completion of phase III randomized clinical trials, the oral direct thrombin inhibitors (e.g. dabigatran) and oral direct inhibitors of factor Xa (e.g. rivaroxaban, apixaban) have emerged recently as an alternative for stroke prevention in AF. Thromboprophylaxis in AF also may be accomplished by non-pharmacological methods of percutaneous transcatheter mechanical occlusion of left atrial appendage. So far, several mechanical occluders have been constructed and this form of prevention may be an alternative method of thromboprophylaxis in patients with AF who experienced significant hemorrhagic complications with oral VKA or where the use of VKA is contraindicated. In this review article, we summarize the current knowledge on the VKA, novel oral anticoagulants and non-pharmacological methods of thromboprophylaxis in AF for stroke and thrombo-embolism prevention in AF.