Atrial fibrillation and stroke prevention

There is overwhelming evidence from randomized trials and systematic reviews to indicate the benefit of thromboprophylaxis in patients with atrial fibrillation. In moderate- to high-risk subjects, oral anticoagulation with warfarin reduces stroke by two-thirds, while aspirin reduces stroke by 22%. The latter result is similar to that seen for stroke reduction with antiplatelet therapy in vascular disease. Numerous studies have shown that less than half the patients eligible for warfarin therapy actually receive it and under- or overanticoagulation is common. This leads to many missed opportunities in optimizing stroke prevention in atrial fibrillation. The limitations of existing oral anticoagulants have resulted in the development of many new drugs. The aim of this review is to provide a brief overview of thromboprophylaxis in atrial fibrillation, and the opportunities for improvement in the provision made for thromboprophylaxis.