Abstract
Atrial fibrillation is the most common form of arrhythmia, affecting approximately 60 million patients worldwide.1 The risk of stroke in atrial fibrillation patients is higher than in the general population, and atrial fibrillation also increases the risk of mortality. Currently, the use of anticoagulants to prevent stroke and systemic embolism is one of the important pillars in managing atrial fibrillation. For many years in Vietnam and around the world, vitamin K antagonists were almost the only anticoagulant option for stroke prevention in atrial fibrillation patients. However, the use of and adherence to vitamin K antagonists faced many challenges due to the inherent disadvantages of the drug, such as a narrow therapeutic range, unpredictable effects, and numerous interactions with food and concomitant medications. The emergence of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) has created a major advancement in stroke prevention for atrial fibrillation patients. NOACs not only overcome the drawbacks of vitamin K antagonists but also show advantages in efficacy and safety. To date, NOACs are the first-line choice for stroke prevention in atrial fibrillation patients when there are no contraindications.2 The simultaneous availability of all 4 NOACs in Vietnam provides clinicians with many good options, however, the question of which NOAC to choose in specific clinical situations remains unanswered as there are no randomized, controlled, head-to-head comparison studies between NOACs. At the end of 2023, a group of Vietnamese cardiology and stroke experts published guidelines for selecting NOACs in atrial fibrillation patients based on clinical characteristics in the European Cardiology Review, which somewhat answered the above question.3,4 The important contents of the two parts of the recommendation will be summarized below.