Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Mar 7;13(3):660.
doi: 10.3390/biomedicines13030660.

Non-Anticoagulation Strategies Aimed at Primary Stroke Prevention in Nascent Atrial Fibrillation

Luca Sgarra  1 , Vanessa Desantis  2 , Andrea Matteucci  3   4 , Vincenzo Paolo Caccavo  1 , Federica Troisi  1 , Antonio Di Monaco  1 , Francesco Mangini  1 , Grigorios Katsouras  1 , Andrea Igoren Guaricci  5 , Michele Luca Dadamo  5 , Fabrizio Fortunato  6 , Carmela Nacci  2 , Maria Assunta Potenza  2 , Monica Montagnani  2 , Massimo Grimaldi  1
Affiliations
Review

Non-Anticoagulation Strategies Aimed at Primary Stroke Prevention in Nascent Atrial Fibrillation

Luca Sgarra et al. Biomedicines. .

Abstract

At its earliest appearance, atrial fibrillation (AF) is often unnoticed, asymptomatic, and/or merely device-detected. Widespread use of heart-rate monitoring technologies has facilitated such "nascent atrial fibrillation (nAF)" recognition. Consequently, clinicians face a growing number of patients affected by new-onset AF in the absence of a definite indication for anticoagulation due to several counterarguments: (1) a CHA2DS2-VA score ≤ 1 in otherwise apparently healthy subjects; (2) an uncertain embolic/hemorrhagic benefit/risk ratio with anticoagulation; (3) EKG demonstration and confirmation of AF; and (4) existence of a pathogenic mechanism other than atrial hypercoagulability. In this frustrating limitation of pharmacological options, cardiologists may miss a complete comprehension of drugs with proven anti-ictal potential, whose administration may serve both as a bridge strategy toward future anticoagulation and as a consolidative strategy paralleling anticoagulation. This review aims to summarize and elucidate such therapeutic strategies and their preventative mechanisms.

Keywords: atrial fibrillation; preventive therapy; stroke.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Primary prevention drug strategies according to incremental CV risk.
Figure 2
Figure 2
Quadrant-based graph of described treatments based on their effects on AF and stroke onset.
See this image and copyright information in PMC

References

    1. Van Gelder I.C., Rienstra M., Bunting K.V., Casado-Arroyo R., Caso V., Crijns H., De Potter T.J.R., Dwight J., Guasti L., Hanke T., et al. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) Eur. Heart J. 2024;45:3314–3414. doi: 10.1093/eurheartj/ehae176. - DOI - PubMed
    1. Vitolo M., Imberti J.F., Maisano A., Albini A., Bonini N., Valenti A.C., Malavasi V.L., Proietti M., Healey J.S., Lip G.Y., et al. Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: A systematic review and meta-analysis. Eur. J. Intern. Med. 2021;92:100–106. doi: 10.1016/j.ejim.2021.05.038. - DOI - PubMed
    1. Miyazawa K., Pastori D., Martin D.T., Choucair W.K., Halperin J.L., Lip G.Y.H., Investigators I.S. Characteristics of patients with atrial high rate episodes detected by implanted defibrillator and resynchronization devices. Europace. 2022;24:375–383. doi: 10.1093/europace/euab186. - DOI - PMC - PubMed
    1. Kaufman E.S., Israel C.W., Nair G.M., Armaganijan L., Divakaramenon S., Mairesse G.H., Brandes A., Crystal E., Costantini O., Sandhu R.K., et al. Positive predictive value of device-detected atrial high-rate episodes at different rates and durations: An analysis from ASSERT. Heart Rhythm. 2012;9:1241–1246. doi: 10.1016/j.hrthm.2012.03.017. - DOI - PubMed
    1. Sagris D., Georgiopoulos G., Pateras K., Perlepe K., Korompoki E., Milionis H., Tsiachris D., Chan C., Lip G.Y.H., Ntaios G. Atrial High-Rate Episode Duration Thresholds and Thromboembolic Risk: A Systematic Review and Meta-Analysis. J. Am. Heart Assoc. 2021;10:e022487. doi: 10.1161/JAHA.121.022487. - DOI - PMC - PubMed

LinkOut - more resources