Preventing Stroke in Patients With Atrial Fibrillation—A Steep Climb Away From Achieving Peak Performance | Atrial Fibrillation | JAMA Cardiology | JAMA Network
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Invited Commentary
April 2016

Preventing Stroke in Patients With Atrial Fibrillation—A Steep Climb Away From Achieving Peak Performance

Author Affiliations
  • 1Duke Center for Atrial Fibrillation, Duke University Medical Center, Durham, North Carolina
  • 2Duke Clinical Research Institute, Durham, North Carolina
  • 3Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
  • 4Associate Editor, JAMA Cardiology
JAMA Cardiol. 2016;1(1):63-64. doi:10.1001/jamacardio.2015.0382

There are many ways of going forward, but only one way of standing still.

Franklin D. Roosevelt

Atrial fibrillation (AF) increases the risk of stroke by 5-fold, and more than 40% of all strokes in patients older than 80 years are attributable to AF.1 Worse yet, AF-related thromboembolic events lead to larger infarcts and poorer outcomes, such that patients with AF are more likely to develop significant disability after a stroke.2 Moreover, AF-related strokes are 2.5-fold more likely to be fatal.1 Despite the significant morbidity and mortality due to AF, AF-related strokes can be prevented. Oral anticoagulation has been shown to reduce the risk of stroke by 64% and the risk of death by 26% in patients with AF.3 In fact, oral anticoagulation has been the only intervention to improve survival in randomized clinical trials of AF therapy. For decades, warfarin sodium was the sole oral anticoagulant available for the prevention of AF-related stroke and systemic embolization. However, in the past 6 years, there have been 4 randomized clinical trials of non–vitamin K antagonist oral anticoagulants (NOACs), including more than 71 000 patients.4 These trials revealed that NOACs provide better protection than warfarin, reducing the risk of ischemic stroke by 19% and the risk of intracranial hemorrhage by approximately 50%.4 The medical community now has several highly effective therapies to prevent stroke.