Atrial fibrillation is the most important treatable risk factor for ischemic strokes in 2025 – and at the same time an area where precision makes all the difference. The major upheavals are over: direct oral anticoagulants (DOACs) have replaced vitamin K antagonists as the standard of care. However, the latest guidelines, studies and registry data are shifting the focus away from the question of “which drug?” to the question of “how to use it consistently and correctly?”. At the same time, integrated care concepts such as the ABC pathway place treatment in a patient-centered process that combines OAC, rhythm strategy and comorbidity management. And while clinical research with FXI/XIa inhibitors continues to search for a safety margin, the initial phase 3 results provide a sober interim assessment: proof of concept is still pending.
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