Non-Anticoagulation Strategies Aimed at Primary Stroke Prevention in Nascent Atrial Fibrillation
2025
Luca Sgarra | Vanessa Desantis | Andrea Matteucci | Vincenzo Paolo Caccavo | Federica Troisi | Antonio Di Monaco | Francesco Mangini | Grigorios Katsouras | Andrea Igoren Guaricci | Michele Luca Dadamo | Fabrizio Fortunato | Carmela Nacci | Maria Assunta Potenza | Monica Montagnani | Massimo Grimaldi
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 CHA<sub>2</sub>DS<sub>2</sub>-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.
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