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  • Research & Results
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  • Stroke Prevention in Atrial Fibrillat...

This project has results

Stroke Prevention in Atrial Fibrillation Patients: A Systematic Review Update

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Project Summary

This systematic review (SR) and meta-analysis updates a 2013 report published by the Agency for Healthcare Research and Quality’s Effective Healthcare Program, which evaluated questions related to stroke prevention in patients with atrial fibrillation and atrial flutter. Atrial fibrillation is an irregular heartbeat that can lead to blood clots, stroke, heart failure, and other complications. In atrial flutter, the upper chambers of the heart beat too fast, which results in atrial muscle contractions that are faster than and out of sync with the lower chambers.

Within this systematic review, we will use AF to include patients with either atrial fibrillation and atrial flutter. AF is the most common heart arrhythmia seen in clinical practice. Management of AF involves rate control, rhythm control, and prevention of thromboembolic events. This review update focuses on prevention of thromboembolic events. The key questions (KQs) for this systematic review update derive from the original review and have been updated based on stakeholder feedback obtained by PCORI.

The key questions are: 1) In patients with nonvalvular atrial fibrillation, what are the comparative diagnostic accuracy and impact on clinical decisionmaking (diagnostic thinking, therapeutic and patient outcome efficacy) of available clinical and imaging tools and associated risk factors for predicting thromboembolic risk? 2) In patients with nonvalvular atrial fibrillation, what are the comparative diagnostic accuracy and impact on clinical decisionmaking (diagnostic thinking, therapeutic, and patient outcome efficacy) of clinical tools and associated risk factors for predicting bleeding events? 3) What are the comparative safety and effectiveness of specific anticoagulation therapies, antiplatelet therapies, and procedural interventions for preventing thromboembolic events: a.In patients with nonvalvular atrial fibrillation?, and b.In specific subpopulations of patients with nonvalvular atrial fibrillation?

The review also asks a contextual question, which is not systematically reviewed but uses a "best evidence" approach: What are currently available shared decision-making tools for patient and provider use for stroke prophylaxis in atrial fibrillation, and what are their relative strengths and weaknesses?

View Systematic Review Update Report

Journal Articles

Results of This Project

Thrombosis and Haemostasis

Predicting Thromboembolic and Bleeding Event Risk in Patients with Non-Valvular Atrial Fibrillation: A Systematic Review

Annals of Internal Medicine

Interventions for Preventing Thromboembolic Events in Patients With Atrial Fibrillation: A Systematic Review

More on this Project  

  • Final Protocol for This Review

  • Stakeholder Meeting

Evidence Updates

Reducing Risk of Stroke in Patients with Atrial Fibrillation
People with atrial fibrillation (AFib) have a higher risk for stroke compared with people who have a normal heart rhythm. Medicines that keep blood from clotting, called anticoagulants, lower the risk of stroke but can also cause serious bleeding. A recent review of research found that some newer anticoagulants do better at reducing the risk of stroke, and some also reduce the risk of serious bleeding compared to traditional therapies.

Project Details

Project Status
Completed
Project End Date
October 2018
Organization
Memorandum of Understanding with Agency for Healthcare Research and Quality (AHRQ)
Year Awarded
2017
State
Maryland
Year Completed
2018
Project Type
Research Project
Populations
Racial/Ethnic Minorities
Women
Project Budget
$267,750
Page Last Updated: 
December 2, 2020

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