Consensus on Stroke Prevention in Atrial Fibrillation and Utilization of NOACs in the Real-World Setting in India

Abstract

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia. Prevention of stroke and systemic thromboembolism remains
the cornerstone of the management of AF. Even today, there are unresolved knowledge gaps in AF pathophysiology, screening
and therapeutic strategies and stroke prevention. The modified DELPHI method was used to develop the best practice
recommendations for the management of AF in a real-world setting with the participation of 500 cardiologists across India.
The experts concurred that the decision to initiate antithrombotic treatment in patients with transient AF could be based on
the duration of transient AF, the co-existence of the risk factor for stroke and echocardiographic abnormalities impact the
decision. The decision to initiate anticoagulant therapy in device-detected atrial high-rate episodes (AHRE) can be decided
based on the duration of AHRE, the burden of AHRE and the individual’s risk of stroke and thromboembolism. The benefit
of early anticoagulation should be balanced with the risk of intracerebral hemorrhage (ICH), especially in elderly patients
and in severe strokes. Apixaban is the preferred drug in patients with concomitant ischemic heart disease (IHD), patients
with a history of gastrointestinal (GI) bleeding, patients with underlying malignancy, elderly patients with AF, patients with
comorbid diseases and patients with hepatic disease or renal disease. Apixaban was considered to be an affordable novel
oral anticoagulant (NOAC) for Indian patients for primary and secondary stroke prophylaxis in AF patients