Stroke Prevention in Atrial Fibrillation: Focus on Latin America

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated prevalence of 1-2% in North America and Europe. The increased prevalence of AF in Latin America is associated with an ageing general population, along with poor control of key risk factors, including hypertension. As a result, stroke prevalence and associated mortality have increased dramatically in the region. Therefore, the need for effective anticoagulation strategies in Latin America is clear. The aim of this review is to provide a contemporary overview of anticoagulants for stroke prevention.The use of vitamin K antagonists (VKAs, eg, warfarin) and aspirin in the prevention of stroke in patients with AF in Latin America remains common, although around one fifth of all AF patients receive no anticoagulation. Warfarin use is complicated by a lack of access to effective monitoring services coupled with an unpredictable pharmacokinetic profile. The overuse of aspirin is associated with significant bleeding risks and reduced efficacy for stroke prevention in this patient group. The non-VKA oral anticoagulants (NOACbs) represent a potential means of overcoming many limitations associated with VKA and aspirin use, including a reduction in the need for monitoring and a reduced risk of hemorrhagic events.The ultimate decision of which anticoagulant drug to utilize in AF patients depends on a multitude of factors. More research is needed to appreciate the impact of these factors in the Latin American population and thereby reduce the burden of AF-associated stroke in this region.

Meta-analysis of the efficacy and safety of non-vitamin K antagonist oral anticoagulants with warfarin in Latin American patients with atrial fibrillation

“…The incidence of AF-related thromboembolic events is increasing in Latin America, possibly because of poorly controlled risk factors of AF. [ 14 ] Our current meta-analysis revealed a higher rate of all-cause death and a relatively weak association regarding SSE among LatAm subjects, suggesting the need for an adequate anticoagulation therapy of AF. The higher rate of death in LatAm patients persisted despite adjustment for baseline clinical characteristics.…”

“…However, the quantitative effects of NOACs with warfarin for AF stroke prevention in Latin America remain unclear. [ 14 ] In this meta-analysis, we aimed to compare the efficacy and safety of NOACs with warfarin in Latin American (LatAm) patients with AF.…”

XANTUS-EL: A real-world, prospective, observational study of patients treated with rivaroxaban for stroke prevention in atrial fibrillation in Eastern Europe, Middle East, Africa and Latin America

“…There are important regional global differences in clinical characteristics relevant to patients with AF. For example, in Latin America, the incidence of AF-related stroke and associated morbidity is increasing, possibly due to poorly controlled risk factors, 8 and coronary artery disease is less common in patients with AF from Latin America than in Western patients 9, 10. In the Middle East, patients with AF are approximately 10 years younger than those in Western countries, with higher rates of diabetes and heart failure, 10 but with a relatively high rate (19%) of ‘lone AF’ (i.e.…”

Use of Guidelines for Reducing Stroke Risk in Patients With Nonvalvular Atrial Fibrillation: A Review From a Latin American Perspective

“…Adherence to guidelines can be limited by cost/access issues, which vary across the region. 90 In Brazil, patients treated in the public sector typically continue to receive warfarin or another VKA because these costs are supported by the public system. Only 30% of patients have private health insurance and access to newer therapies (eg, DOACs) for stroke prevention.…”