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

• Published in: Biomedicines Vol. 13; no. 3; p. 660
• Main Authors: Sgarra, Luca, Desantis, Vanessa, Matteucci, Andrea, Caccavo, Vincenzo Paolo, Troisi, Federica, Di Monaco, Antonio, Mangini, Francesco, Katsouras, Grigorios, Guaricci, Andrea Igoren, Dadamo, Michele Luca, Fortunato, Fabrizio, Nacci, Carmela, Potenza, Maria Assunta, Montagnani, Monica, Grimaldi, Massimo
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 07.03.2025; MDPI
• Subjects: Antihypertensive drugs; Asymptomatic; Atherosclerosis; Atrial fibrillation; Behavior modification; Cardioversion; Care and treatment; Cholesterol; Complications and side effects; Diagnosis; Dietary supplements; EKG; Electrocardiography; Enzymes; Fibrillation; Health aspects; Heart rate; Heparan sulfate; Hypoglycemic agents; Inflammation; Ischemia; Lipids; Low density lipoprotein receptors; Methods; Oxidative stress; Patients; Pattern recognition; Physiological aspects; Prevention; preventive therapy; Review; Risk factors; Statins; Stroke; Stroke (Disease); Italy; stroke; atrial fibrillation; preventive therapy
• ISSN: 2227-9059; 2227-9059
• DOI: 10.3390/biomedicines13030660

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.