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Education in Heart
Anticoagulation in atrial fibrillation
  1. Sérgio Barra1,2,
  2. Rui Providência3
  1. 1 Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal
  2. 2 Cardiology Department, Royal Papworth Hospital NHS Trust, Cambridge, UK
  3. 3 Barts Heart Centre, Barts Health NHS Trust, London, UK
  1. Correspondence to Dr Sérgio Barra, Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal; sergioncbarra{at}gmail.com

https://doi.org/10.1136/heartjnl-2020-316728

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    Learning objectives

    • To understand the (high) prevalence of atrial fibrillation (AF) in the overall population and to identify subgroups at higher risk.

    • To understand the diagnostic procedures available to diagnose AF in patients deemed to be at higher risk, such as post-stroke.

    • To recognise and overcome barriers to anticoagulation.

    • To identify patients at higher risk of thromboembolic and haemorrhagic complications.

    • To understand indications for antithrombotic therapy in specific groups of patients with AF.

    One in three of us will be diagnosed with atrial fibrillation (AF) at some point in our lives.1 Over 1.2 million individuals in the UK have been diagnosed with AF, and thousands still remain undiagnosed.2 3 Due to the ageing population, the number of individuals with AF in Europe will double in the next 50 years,3 contrasting with a fall in the incidence of myocardial infarction and stroke over recent decades.4 This shift in cardiovascular epidemiology is important as AF associates with a myriad of cardiovascular and non-cardiovascular complications (figure 1), and contributes to a 1.5-fold to 2.0-fold increase in all-cause mortality.5

    Figure 1

    Clinical events in the atrial fibrillation population. Cerebrovascular complications in red, other cardiovascular events in blue and other risks in green. Relative risk and 95% CIs are illustrated based on Odutayo et al. 5

    The risk of ischaemic stroke in patients with AF is three to five times higher,6 with AF found in up to 30% of patients admitted with ischaemic stroke, and associated with a higher risk of fatal outcome.7 The risk of AF-related stroke can be mitigated through anticoagulation, with a 66% risk reduction with vitamin K antagonists (VKAs) and at least similar effectiveness with non-VKA.8 Stroke rates in patients with adequately anticoagulated AF are similar to those of patients without documented AF,9 with only 1 …

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    Footnotes

    • Contributors Both authors contributed to literature search and manuscript drafting.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement There are no data in this work

    • Author note References which include a * are considered to be key references