Expert Opinion on the Use of Novel Oral Anticoagulants for Stroke Prevention in Non-valvular Atrial Fibrillation for the Primary Care Setting in India: A Literature Review

Cureus. 2022 May 18;14(5):e25102. doi: 10.7759/cureus.25102. eCollection 2022 May.

Abstract

Atrial fibrillation (AF), the most prevalent cardiac arrhythmia encountered in clinical practice, is linked with substantial morbidity and mortality due to accompanying risk of stroke and thromboembolism. Patients with AF are at a five-fold higher risk of suffering from a stroke. Anticoagulation therapy, with either vitamin K antagonists or novel oral anticoagulants (NOACs), is a standard approach to reduce the risk. Consultant physicians (CPs) in India are the primary point of contact for the majority of patients before they approach a specialist. The CPs may face challenges in screening and diagnosing AF patients. The apprehensions associated with managing AF patients with anticoagulants, further add to the challenges of a CP. This review aimed to identify the key decision points for the CPs to diagnose AF and initiate anticoagulation in patients with non-valvular AF (NVAF) and bring to the table a simplified recommendation supported by expert opinion and guidelines for stroke prevention in NVAF patients.

Keywords: atrial fibrillation; frail elderly; hemorrhage; renal insufficiency; stroke.

Publication types

  • Review

Grants and funding

All the authors declare that they received an honorarium as per the fair market value (FMV) from Pfizer for being the expert advisor in the advisory board before the development of the manuscript. None of the authors intend to unduly influence or promote any product through this publication.