Title

Stroke Prevention in Non-Valvular Atrial Fibrillation

Date of Award

Spring 2022

Degree Name

Master of Medical Science (Physician Assistant)

Department

Physician Assistant; College of Health Sciences

First Advisor

Kevin Basile, MD, PT

Second Advisor

Samantha Creamer, PA-C, MPAS

Abstract

Atrial Fibrillation (AF) is the most commonly-treated cardiac arrhythmia in the world. In AF, unsynchronized action potentials in the pulmonary veins and left atrium lead to uneven contractions of the atrial muscle cells, resulting in an irregularly irregular heart rhythm and inadequate blood flow out of the heart. The major complication that stems from untreated AF is a thromboembolic stroke event. While Warfarin has been the long-standing treatment option in preventing stroke, there are several other available options that patients may consider, including Direct Oral Anticoagulants (DOACs), such as Apixaban (aka Eliquis) and Rivaroxiban (aka Xarelto). An additional and more recent option is occlusion of the left atrial appendage (LAAO), a pocket structure and the most common site for thrombus formation. The only FDA approved device in the US currently for LAAO is the WATCHMAN device. This review defines atrial fibrillation, explains different risk assessment tools in stroke prevention, and outlines the available prophylaxis options while weighing risks and benefits.

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Stroke Prevention in Non-Valvular Atrial Fibrillation

Atrial Fibrillation (AF) is the most commonly-treated cardiac arrhythmia in the world. In AF, unsynchronized action potentials in the pulmonary veins and left atrium lead to uneven contractions of the atrial muscle cells, resulting in an irregularly irregular heart rhythm and inadequate blood flow out of the heart. The major complication that stems from untreated AF is a thromboembolic stroke event. While Warfarin has been the long-standing treatment option in preventing stroke, there are several other available options that patients may consider, including Direct Oral Anticoagulants (DOACs), such as Apixaban (aka Eliquis) and Rivaroxiban (aka Xarelto). An additional and more recent option is occlusion of the left atrial appendage (LAAO), a pocket structure and the most common site for thrombus formation. The only FDA approved device in the US currently for LAAO is the WATCHMAN device. This review defines atrial fibrillation, explains different risk assessment tools in stroke prevention, and outlines the available prophylaxis options while weighing risks and benefits.