Atrial fibrillation and prevention of thromboembolic events

a review of current strategies

Abstract

Atrial fibrillation represents the most prevalent sustained supraventricular tachyarrhythmia in global clinical practice, configuring a serious public health problem due to its direct impact on cardiovascular morbidity and mortality and the risk of ischemic stroke. This review article analyzes and synthesizes contemporary pharmacological and non-pharmacological strategies aimed at preventing thromboembolic events in these patients. Methodologically, a systematic survey of high-impact national and international guidelines, controlled clinical trials, and metaanalyses was conducted. The results point to a paradigmatic shift in risk stratification, centered on objective structural comorbidities, in addition to the definitive consolidation of direct oral anticoagulants as first-line therapy due to their predictable pharmacokinetics and superior hemorrhagic safety profile. Additionally, percutaneous occlusion of the left atrial appendage is established as an effective mechanical alternative in scenarios of long-term pharmacological contraindication. It is concluded that an integrated and holistic approach, uniting the precision of modern anticoagulation with the rigorous management of underlying risk factors, is indispensable to mitigate catastrophic peripheral outcomes. However, gaps regarding the underrepresentation of populations with end-stage renal disease demand attention, suggesting that future investigations explore new factor XI inhibitors and the use of wearable devices to refine precision medicine in cardiology.