RECENT ADVANCES IN MANAGEMENT OF ANTI-COAGULATION IN ATRIAL FIBRILLATION

Atrial fibrillation (AF) is the most common cardiac arrhythmia characterized by uncoordinated electrical activity resulting in increased irregular atrial contraction that ultimately leads to rapid ventricular response. Cardioembolic stroke is one of the major complications of AF and it is responsible for significant embolic events in elderly patients. Cardioembolic stroke accounts for up to 20 % of strokes and the incidence increases with advancing age. Current guidelines recommend anticoagulation for AF with high risk factors for emboli based on CHAD2DS2-Vasc scoring system. Recently, two major classes of non-vitaminK oral anti-coagulants (NOACs) have become available for long-term anti-coagulation in AF: direct thrombin inhibitor (DTI) and factor Xa inhibitor. Here, we discuss the benefits of NOACs over warfarin in specific patient groups with practical guidance on treatment and monitoring strategies. We will highlight the challenges that clinicians face in the modern era of NOACs. We will further discuss the strategies for bleeding prevention and treatment and conclude with discussing future directions in management of AF.