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NOACs Recommended as First-Line Prevention of Stroke in A-Fib

TUESDAY, Jan. 29, 2019 -- For patients with atrial fibrillation, novel oral anticoagulants (NOACs) are recommended over warfarin to prevent stroke and weight loss is recommended for overweight and obese individuals, according to updated guidelines published online Jan. 28 in Circulation.

Craig T. January, M.D., Ph.D., from the University of Wisconsin-Madison, and colleagues updated the 2014 AF guideline to include revisions relating to anticoagulation, catheter ablation, management of AF complicating acute coronary syndrome, and weight loss.

The authors present several new and modified recommendations. These recommendations include using NOACs as first-line therapy for eligible patients based on consistent evidence of at least noninferiority to warfarin for the combined end point of stroke or systemic embolism and a superior safety profile; exclusion criteria are defined as moderate-to-severe mitral stenosis or a mechanical heart valve. In addition, new data demonstrate the beneficial effects of weight loss and modification of risk factors. A structured weight management program reduced symptom burden and severity for obese patients with symptomatic AF and reduced the number of AF episodes and their cumulative duration over risk factor management alone. The degree of improvement in AF type and symptoms was correlated with the degree of weight loss in observational studies.

"Atrial fibrillation patients should talk to their health care provider about any concerns they have about their prescribed medications and whether or not losing weight would benefit their health," January said in a statement.

Several authors disclosed financial ties to the pharmaceutical and medical device industries.

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Posted: January 2019

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