title: Stroke prevention in atrial fibrillation--an Asian stroke perspective.
abstract: Despite relatively lower prevalence of atrial fibrillation (AF) in Asians (~1%) than in Caucasians (~2%), Asia has a much higher overall disease burden because of its proportionally larger aged population. For example, on the basis of reported age-adjusted prevalence rates and projected population figures in China, there will be an estimated 5.2 million men and 3.1 million women with AF older than 60 years by year 2050. Stroke is a disabling complication of AF that is of increasing cause for concern in Asians patients. Implementing consensus expert recommendations for managing stroke risk in patients with AF can considerably reduce stroke rates. However, caution is necessary when aligning management of Asian patients with AF to that of their Caucasian counterparts. Current international guidelines and risk stratification tools for AF management are based on findings in predominantly Caucasian populations and may therefore have limited relevance, in certain respects, to Asian patients. Oral anticoagulants play an important role in preventing AF-related stroke. The vitamin K antagonist warfarin is recommended for reducing the risk of stroke and thromboembolism in high-risk patients with nonvalvular AF; however, warfarin interacts with many drugs and food ingredients, which may pose significant challenges in administration and monitoring among Asian patients. Further research is needed to inform specific guidance on the implications of different stroke and bleeding profiles in Asians vs Caucasians. Moreover, there is scope to improve physician perceptions and patient knowledge, as well as considering alternative new oral anticoagulants, for example, direct thrombin inhibitors or factor Xa inhibitors.
authors.affiliation: Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong. hftse@hkucc.hku.hk
authors.forename: Hung-Fat
authors.initials: HF
authors.lastname: Tse
authors.forename: Yong-Jun
authors.initials: YJ
authors.lastname: Wang
authors.forename: Moheeb
authors.initials: M
authors.lastname: Ahmed Ai-Abdullah
authors.forename: Annette B
authors.initials: AB
authors.lastname: Pizarro-Borromeo
authors.forename: Chern-En
authors.initials: CE
authors.lastname: Chiang
authors.forename: Rungroj
authors.initials: R
authors.lastname: Krittayaphong
authors.forename: Balbir
authors.initials: B
authors.lastname: Singh
authors.forename: Amit
authors.initials: A
authors.lastname: Vora
authors.forename: Chun-Xue
authors.initials: CX
authors.lastname: Wang
authors.forename: Mohammad
authors.initials: M
authors.lastname: Zubaid
authors.forename: Andreas
authors.initials: A
authors.lastname: Clemens
authors.forename: Paul
authors.initials: P
authors.lastname: Lim
authors.forename: Dayi
authors.initials: D
authors.lastname: Hu
mesh_terms: D044466:Asian People; D001281:Atrial Fibrillation / Q000150:complications*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D014943:Global Health; D006801:Humans; D015994:Incidence; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
chemical_list: D005343:Fibrinolytic Agents