Anticoagulant therapy in atrial fibrillation

The clinical benefit of long-term oral anticoagulant therapy in patients with atrial fibrillation (AF) and high thromboembolic risk is supported by a sound body of evidence. Over the past decade, the management of thromboembolic risk has been considerably impacted by the marketing of direct oral anticoagulants (AODs). Compared to classic vitamin K antagonists (VKA) therapies, AODs have been shown to be more effective in terms of thromboembolic prevention, mortality and clinical outcomes, and safer by reducing major bleeding (in particular intracranial hemorrhages). Their clinical benefit and ease of use have made them the first-line treatment in non-valvular AF, including in frail and/or elderly patients. VKA remains the standard of care in valvular AF. This review focuses on the different anticoagulant therapies available in AF, their mechanisms of action, the good prescribing practices as well as their clinical benefit and their conditions of use in real life. (C) 2020 Published by Elsevier Masson SAS on behalf of l'Academie nationale de medecine.