Stroke prevention in patients with
atrial fibrillation (AF) is one pillar of the management of this common
arrhythmia. Substantial advances in the epidemiology and associated pathophysiology underlying AF-related
stroke and thrombo-
embolism are evident. Furthermore, the introduction of the non-
vitamin K antagonist oral
anticoagulants (also called direct oral
anticoagulants) has clearly changed our approach to
stroke prevention in AF, such that the default should be to offer oral anticoagulation for
stroke prevention, unless the patient is at low risk. A strategy of early rhythm control is also beneficial in reducing
strokes in selected patients with recent onset AF, when compared to rate control. Cardiovascular risk factor management, with optimization of comorbidities and attention to lifestyle factors, and the patient's psychological morbidity are also essential. Finally, in selected patients with absolute
contraindications to long-term oral anticoagulation, left atrial appendage occlusion or exclusion may be considered. The aim of this state-of-the-art review article is to provide an overview of the current status of AF-related
stroke and prevention strategies. A holistic or integrated care approach to AF management is recommended to minimize the risk of
stroke in patients with AF, based on the evidence-based
Atrial fibrillation Better Care (ABC) pathway, as follows: A: Avoid
stroke with Anticoagulation; B: Better patient-centred, symptom-directed decisions on rate or rhythm control; C: Cardiovascular risk factor and comorbidity optimization, including lifestyle changes.