Stroke Prevention in Asian Patients With Atrial Fibrillation

See related article, p 1739.Atrial fibrillation (AF) is a global problem, contributing to a significant burden of mortality and morbidity, particularly from stroke and systemic thromboembolism.1,2 Effective stroke prevention requires oral anticoagulation (OAC), and until recently our options were limited to the vitamin K antagonist (VKA; eg, warfarin) class of drugs. VKAs were an inconvenient drug that required regular monitoring to keep within a relatively narrow therapeutic range, and the efficacy and safety were dependent on treatment adherence and good quality anticoagulation control (as reflected by a time in therapeutic range [TTR]).3,4 In Asian patients, the VKAs have additional issues, when compared with non-Asians, they have a higher risk for intracranial bleeding, major hemorrhage, and stroke, as well as difficulties in maintaining a high TTR.5 There was also uncertainty over what was the optimal target international normalized ratio (INR) range in Asians, which was perceived to be lower than the range recommended in non-Asians (ie, INR, 2.0–3.0).The availability of the non-VKA OACs (NOACs; previously referred to as new or novel OACs)6 has resulted in a major change in the landscape for stroke prevention, given that these drugs offer relative efficacy, safety, and convenience when compared with the VKAs. Trials in Asian patients7,8 and ancillary publications from the large Phase 3 clinical trials comparing Asian versus non-Asian patients all consistently show that NOACs offer effective and safe options for stroke prevention when compared with VKAs.9–11 Expectations are, therefore, …