Overview of prevention of thromboembolic events in atrial fibrillation

Patients with atrial fibrillation have a higher mortality rate than the general population—most of the mortality is due to thromboembolic complications (such as stroke). All types of atrial fibrillation are associated with a risk of stroke and thromboembolism; this risk is greater in patients with persistent rather than paroxysmal atrial fibrillationGanesan, 2016 Hindricks, 2021.

As soon as atrial fibrillation is diagnosed, assess the patient’s stroke risk. Start anticoagulant therapy if appropriate as it can reduce stroke risk by up to 70%Hindricks, 2021; this does not routinely require specialist management. In the management of atrial fibrillation, anticoagulant therapy is generally used concurrently with treatment for the arrhythmia.

Note: As soon as atrial fibrillation is diagnosed, assess the patient’s stroke risk and start anticoagulant therapy if appropriate.

Anticoagulant therapy is usually needed long term whether a rate control strategy or a long-term rhythm control strategy is adopted. For patients electrically or pharmacologically cardioverted, anticoagulant therapy is often required before cardioversion, and should be used for at least 4 weeks after cardioversion—see General principles of acute rhythm control for more details.

For more information, see Stroke and bleeding risk assessment for atrial fibrillation and Anticoagulant therapy to prevent thromboembolic events in atrial fibrillation.