Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update

Abstract

The information in this report is intended to help health care decisionmakers-patients and clinicians, health system leaders, and policymakers, among others-make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.This report is made available to the public under the terms of a licensing agreement between the author and AHRQ. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. PCORI, AHRQ, or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at: www.effectivehealthcare.ahrq.gov. Search on the title of the report.

Real-World Persistence and Time to Next Treatment With Ibrutinib in Patients With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Including Patients at High Risk for Atrial Fibrillation or Stroke

“…31 The CHARGE-AF risk score was created as part of a which showed a better predictive value. 31 Given that stroke is a complication of AF 32 , the CHA 2 DS 2 -VASc score is often calculated in patients with AF. However, CHA 2 DS 2 -VASc's applicability to patients without AF has also been demonstrated in two large population studies; in the Atherosclerosis Risk in Communities study (N=10,671), a higher CHA 2 DS 2 -VASc score was associated with higher risk of stroke including embolic stroke-the type associated with AF-in people without AF 33 ; and in the Chin-Shan Community Cohort study (N=3,524), CHA 2 DS 2 -VASc score had comparable predictive value for stroke in non-AF and AF populations.…”

A New Vision at the Interface of Atrial Fibrillation and Stroke

“…In recent years, the adoption of clinical tools with the objective of stratifying the risk of stroke, the most used being the CHA2DS2VASC scheme (age, sex, heart failure, or previous neurological vascular event parameters) ( 54 ). Although widely accepted by cardiology societies, its ability to predict the event is suboptimal [C statistic, 0.64; 95% confidence interval (CI), 0.58–0.70] ( 55 ).…”

Anticoagulation in the HeartMate 3 Left Ventricular Assist Device: Are We Finally Moving the Needle?

“…There is now evidence that for stroke prevention in atrial fibrillation, apixaban may have the lowest stroke and bleeding rates compared with other DOACs. 7,8 So it is possible that apixaban may also have lower stroke and bleeding rates than dabigatran in LVAD patients. Second, in the RCT by Andreas et al , all four patients in the dabigatran group who experienced thromboembolic events had device thrombosis, three while on dabigatran, and one discovered shortly after switch to phenprocoumon.…”