Hersi Ahmad S, Alhebaishi Yahya S, Hamoui Omar, Hassan Taher, Khalifa Hamad Adel, Magdy Mohamed, Sabbour Hani, Shaheen Sameh
King Fahad Cardiac Center, Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
J Saudi Heart Assoc. 2018 Apr;30(2):122-139. doi: 10.1016/j.jsha.2017.05.001. Epub 2017 Jun 8.
Clinical guidelines for the prevention of stroke in patients with nonvalvular atrial fibrillation (NVAF) are available from several international cardiology associations. Patients with NVAF in the Middle East and North Africa (MENA) region present unique challenges and opportunities related to differences in geography, practice patterns, and patient demographics that are as yet unaddressed in practice guidelines. This review aims to offer a practical perspective on the management of NVAF in patients in MENA and draws on evidence-based guidelines as well as real-world evidence and expert opinion. The literature was searched for relevant original research articles, systematic reviews, meta-analyses, and guideline recommendations addressing the prevention of stroke in patients with NVAF with a focus on issues relevant to the MENA region. Guideline recommendations, best practices, and expert opinion were discussed and agreed on by a working group consisting of cardiologists from across the MENA region. The incidence of stroke secondary to atrial fibrillation in patients across the MENA region is higher than rates reported globally, and this might be attributed to a higher incidence of vascular risk factors and underuse of anticoagulants in patients in the MENA. The available evidence supports the established role of non-vitamin K antagonist oral anticoagulants (NOACs) in the prevention of stroke in patients with NVAF. There is a consistent body of clinical trial and real-world evidence supporting their efficacy for stroke prevention in NVAF, with more favorable bleeding risk profiles relative to vitamin K antagonists, such that guidelines now recommend the use of NOACs in preference over vitamin K antagonists. There are important opportunities to improve the management of NVAF outcomes for patients with NVAF by applying evidence-based guidelines for stroke prevention. Growing experience with NOACs in the MENA region will help guide patient selection and elucidate optimal dosing strategies to maximize the clinical benefits of the NOACs.
几个国际心脏病学协会都发布了非瓣膜性心房颤动（NVAF）患者的卒中预防临床指南。中东和北非（MENA）地区的NVAF患者面临着独特的挑战和机遇，这些挑战和机遇与地理、实践模式以及患者人口统计学差异有关，而实践指南中尚未涉及这些内容。本综述旨在为MENA地区患者的NVAF管理提供实用观点，并借鉴循证指南、真实世界证据和专家意见。检索了相关原始研究文章、系统评价、荟萃分析以及针对NVAF患者卒中预防的指南推荐文献，重点关注与MENA地区相关的问题。由来自MENA地区的心脏病专家组成的工作组讨论并商定了指南推荐、最佳实践和专家意见。MENA地区患者因心房颤动继发卒中的发生率高于全球报告的发生率，这可能归因于该地区患者血管危险因素的发生率较高以及抗凝剂使用不足。现有证据支持非维生素K拮抗剂口服抗凝药（NOACs）在NVAF患者卒中预防中的既定作用。有一系列一致的临床试验和真实世界证据支持其在NVAF卒中预防中的疗效，相对于维生素K拮抗剂，其出血风险特征更有利，因此现在指南推荐优先使用NOACs而非维生素K拮抗剂。通过应用基于证据的卒中预防指南，有重要机会改善NVAF患者的NVAF管理结局。MENA地区对NOACs的经验不断积累，将有助于指导患者选择并阐明最佳给药策略，以最大化NOACs的临床益处。
