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SUMMARY Atrial fibrillation (AF) confers a significant risk of ischemic stroke, and oral anticoagulation is the most effective therapy for thromboprophylaxis in AF. Until recently, vitamin K antagonists (VKAs) were the only available oral anticoagulants. However, numerous disadvantages of VKAs and anticipated bleeding risk with treatment have resulted in their substantial underutilization in clinical practice. Recently, the two other classes of oral anticoagulants – direct thrombin inhibitors (e.g., dabigatran) and direct factor Xa inhibitors (e.g., rivaroxaban and apixaban) – have emerged as a viable alternative to VKAs for stroke prevention in AF. In addition, efforts have been made to facilitate the optimal prevention of AF-related stroke by improvement of both stroke and bleeding risk assessment. In this review, we summarize the recent advances and discuss the contemporary practical aspects of stroke prevention in patients with nonvalvular AF.

The CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroketransient ischemic attack TIA, Vascular disease, Age 65–74 years, and Sex category female gender) schema recently has been introduced to complement the CHADS2(Congestive heart failure, Hypertension, Age >75 years, Diabetes mellitus, and previous stroke or TIA) score and improve the identification of atrial fibrillation (AF) patients at “truly low risk” for thromboembolism. We tested the predictive ability of the CHA2DS2-VASc, CHADS2, and van Walraven risk stratification schemes in a cohort of “lone” AF patients with a 12-year follow-up.

Lone atrial fibrillation (AF) has been suggested to have a favorable long-term prognosis. Significant interest has been directed at factors predicting arrhythmia progression, and the HATCH score (hypertension, age ≥ 75 years, transient ischemic attack or stroke [2 points], COPD, and heart failure [2 points]) recently has been proposed as a predictive score for AF progression. We investigated long-term outcomes in a large cohort of newly diagnosed lone AF and whether progression from paroxysmal to permanent AF confers an adverse impact on outcomes, including stroke and thromboembolism.

Mitral annular calcification (MAC) has been suggested as a reliable, time-averaged marker of atherosclerosis and is associated with coronary artery disease, heart failure, ischemic stroke, and increased mortality. Data on the relationship between MAC and cardiovascular morbidity and mortality in atrial fibrillation (AF) are sparse, with the exception of the relationship between MAC and stroke. We investigated the association of MAC with cardiovascular morbidity, stroke, cardiovascular mortality, and all-cause death in a cohort of middle-aged patients with AF with a mean 10-year follow-up.