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Expert Review

Proper Use of Anticoagulants for Stroke Prevention in Atrial Fibrillation

Cardiology / Neurology

Chapter 1: Stroke Prevention in Atrial Fibrillation: The Guidelines

Gustavo Saposnik, MD MPH FRCPC
Associate Professor of Neurology
HSF Canada Career Scientist
Director, Outcomes Research & Decision Neuroscience Unit
St Michael’s Hospital, University of Toronto
Toronto, Ontario

In the setting of atrial fibrillation (AF), anticoagulation significantly reduces the risk of stroke. Yet, studies have shown repeatedly that AF patients have not received appropriate anticoagulation whether the goal is primary or secondary prevention. The problems have included failure to place AF patients on any anticoagulation, failure to employ a therapeutic dose, and failure of patients to adhere to their prescription. Understanding the reasons for the disappointing adherence to guidelines provides an opportunity to reverse an ongoing source of preventable mortality and morbidity. The goal of this program will be to emphasize the risk of stroke in patients with AF and clarify the evidence-based strategies for the proper management of AF patients whether preventing a first stroke or recurrent strokes. With greater adherence to proper use of anticoagulation, a substantial reduction in preventable morbidity and stroke-related death can be anticipated.

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