Atrial fibrillation is associated with increased risk for cardioembolic stroke. The risk of cardioembolism is not adequately reduced with the administration of oral anticoagulants, since a number of patients continue to experience thromboembolic events despite receiving anti-thrombotic treatment. Several biomarkers have been proposed to predict cardioembolic stroke in patients with atrial fibrillation. Some of them are already used in the clinical practice, such as D-Dimers, Troponin and brain natriuretic peptide. Novel ones such as the inflammatory growth differentiation factor-15, appear to be promising, while the role of micro-RNAs and genetics appear to be useful as well. Even though these biomarkers are associated with an increased risk for thromboembolism, they cannot accurately predict future events. In this light, the use of a scoring system, that would incorporate both circulating biomarkers and clinical factors, might be more useful. Therefore, further research is required to establish a multifactorial scoring system that will identify patients at high-risk for thromboembolism, who will benefit from more intensive treatment and monitoring.
Specific agents, such as vorapaxar and cilostazol, have been found to reduce platelet reactivity as well as to improve patients' prognosis. Of note, the use of novel antiplatelets is of clinical importance in patients with increased thrombotic status and in those with resistance to classic antiplatelets. However, the available data on most of the novel antiplatelets are mainly derived from studies including ACS patients undergoing angioplasty Therefore, large randomized controlled studies are required to evaluate the clinical benefit of novel antiplatelets in patients with stable CAD.
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