title: Evolving strategies to prevent stroke and thromboembolism in nonvalvular atrial fibrillation.
abstract: Stroke prevention in patients with nonvalvular atrial fibrillation relies on an assessment of the individual risks for stroke and bleeding. Patients at high risk for stroke are candidates for anticoagulant therapy. Anticoagulants, however, have substantial bleeding risks that must be weighed in the therapeutic decision. Warfarin has been the traditional choice, but the recently introduced novel oral anticoagulants offer similar efficacy with less bleeding risk. Additionally, they do not require monitoring and have fewer drug interactions and dietary restrictions than warfarin. Several devices, which isolate the left atrial appendage, have become available as treatment options for patients with elevated risks of both thromboembolism and bleeding complications.
authors.affiliation: Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ayman
authors.initials: A
authors.lastname: Hussein
authors.affiliation: Medical Director, Center for Atrial Fibrillation, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.affiliation: Director, Outpatient Electrophysiology Department, Cleveland Clinic, Cleveland, OH, USA.|Co-Director, Ventricular Arrhythmia Center, Cleveland Clinic, Cleveland, OH, USA.|Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA. E-mail: waznio@ccf.org.
authors.forename: Oussama M
authors.initials: OM
authors.lastname: Wazni
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D000069604:Dabigatran / Q000627:therapeutic use; D004864:Equipment and Supplies; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008026:Ligation; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011720:Pyrazoles / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D000069552:Rivaroxaban / Q000627:therapeutic use; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran; D001241:Aspirin