Worldwide trends in antithrombotic therapy prescribing for atrial fibrillation: observations on the ‘transition era’ to non-vitamin K antagonist oral anticoagulants

This editorial refers to ‘Worldwide trends in oral anticoagulant use in patients with atrial fibrillation from 2010 to 2018: a systematic review and meta-analysis’ by M. Grymonprez et al., doi: 10.1093/europace/euab303. The landscape of atrial fibrillation (AF) management has changed substantially over the last decade. Key milestones for stroke prevention have included the introduction of non-vitamin K antagonist (VKA) oral anticoagulants (NOACs), replacement of the CHADS2 stroke risk assessment with CHA2DS2-VASc, guideline updates to offer oral anticoagulants (OAC) to prevent AF-related stroke instead of antiplatelet therapy, and a preference to prescribe NOAC instead of VKA (Figure 1). These changes have increased the proportion of OAC eligible AF patients and have been the catalyst for the ‘transition era’, where we have moved away from a period dominated by VKA use for stroke prevention, to a new era of NOACs. In addition, adherence...