Is bleeding a necessary evil? the inherent risk of antithrombotic pharmacotherapy used for stroke prevention in atrial fibrillation

Aung Myat, Yousif Ahmad, Shouvik Haldar, Udaya S. Tantry, Simon R. Redwood, Paul A. Gurbel, Gregory Y.H. Lip

Research output: Contribution to journalReview article

Abstract

Current European atrial fibrillation (AF) guidelines have assigned a strong recommendation for the initiation of antithrombotic therapy to prevent thromboembolism in all but those AF patients at low risk (or with contraindications). Furthermore, the selection of antithrombotic therapy is based on the absolute risks of thromboembolism and bleeding, and the relative risk and benefit for a given patient. By their very mechanism of action, antithrombotic agents used for stroke prevention in AF will potentially increase the risk of bleeding events. Moreover, the introduction of novel oral anticoagulation agents have introduced new, hitherto ill-defined, deficiencies in the authors' knowledge with respect to anticoagulation monitoring, availability of direct antidotes, drug-drug interactions and the ability to appropriately control and reverse their actions if bleeding events occur. The authors present a comprehensive review on all aspects of bleeding related to currently licensed antithrombotic agents used for stroke prevention in patients with AF.

Original languageEnglish (US)
Pages (from-to)1029-1049
Number of pages21
JournalExpert review of cardiovascular therapy
Volume11
Issue number8
DOIs
StatePublished - Aug 1 2013

Keywords

  • apixaban
  • aspirin
  • atrial fibrillation
  • clopidogrel
  • dabigatran
  • novel oral anticoagulant
  • rivaroxaban
  • stroke
  • thromboembolism
  • warfarin

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

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