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Atrial fibrillation patients are 2–7 times more likely to suffer a stroke!YB1 innovative thrombolytic therapy to help combat cardiovascular disease

The heartbeat is the most intuitive ‘vital sign’ to the average person, who relies on the regular beating of the heart to maintain an orderly life. A change in the heart rate, whether too fast or too slow, is a sign of an abnormality in the heart’s health and requires prompt adjustment and treatment.

In medical terms, when your heart is racing, and your mind is foggy, it can also be a warning sign from your cardiovascular system, as arrhythmia is a common cardiovascular disease.

Generally, cardiovascular disease affects blood flow by blocking or weakening blood vessels or damaging valves in veins. As the cardiovascular disease weakens or completely blocks blood flow, organs and other body structures may be damaged as a result.

In addition to the well-known cardiovascular diseases such as stroke, the incidence of arrhythmias is also high worldwide, and atrial fibrillation is the most common type of arrhythmia.

What is atrial fibrillation?

Atrial fibrillation, or AF, is a trembling or irregular heartbeat leading to blood clots and strokes. While the average heartbeat is rhythmic, in AF, the regular diastole of the atria becomes fibrillation, and the ventricular beat becomes irregular.

The human heart acts as a pump, pumping blood throughout the body with each beat, supplying oxygen and nutrients to the tissues and organs of the body. This mechanical activity of the heart is controlled and governed by electrical activity, which generally originates from the sinus node located in the atria, which regularly sends out electrical impulses, 60–100 times per minute, to all parts of the heart, causing a sequential and regular contraction of all parts of the heart (atria to ventricles).

In atrial fibrillation, the heart’s electrical activity is no longer governed by the sinus node and is replaced by rapid, disorganized electrical activity in the atria, with a corresponding rapid and irregular contraction and diastole of the ventricles. In atrial fibrillation, the volume of blood discharged from the heart is reduced by more than a quarter, or even up to 50%, significantly if there is impaired ventricular function.

The dangers associated with atrial fibrillation are naturally significant — atrial fibrillation can induce or aggravate heart failure and pulmonary oedema and induce myocardial ischaemia. As the atria lose their ability to contract, it can easily lead to the formation of blood clots in the atria, which can be dislodged and cause a cerebral embolism or other peripheral vascular embolisms.

As the atria do not contract regularly, the blood in them can flow chaotically or stagnate, making it easy to form blood clots, which can embolize vital organs along the arteries from the atria. The most serious of which is in the cerebral arteries, leading to strokes, and strokes caused by atrial fibrillation have a high rate of disability and death. In addition, in atrial fibrillation, the heart rate may be rapid, reaching 100–175 beats per minute, and prolonged rapid heart rate can lead to heart failure.

Atrial fibrillation has the highest prevalence of any arrhythmia disease. The incidence of atrial fibrillation increases with age, with a significant increase after the age of 60. Due to the ageing population, China has a large population of people with AF, with statistics showing that the number of people with AF in China will reach 10.8 million in 2020 and is expected to reach 11.1 million by 2030. Globally, the number of people living with AF has increased steadily from 54.7 million in 2016 to 61.3 million in 2020 and is expected to reach 74.8 million by 2030.

Studies have shown that early diagnosis of AF is essential for stroke prevention and treatment.

Atrial fibrillation is the most common persistent arrhythmia and an independent risk factor for stroke. Professional findings show that the prevalence of atrial fibrillation is also strongly associated with conditions such as coronary heart disease, hypertension, and heart failure. Follow-up data show that people with atrial fibrillation have a risk of stroke two to seven times higher than those with atrial fibrillation average.

Publicly available data show that the overall incidence of stroke in Chinese patients with atrial fibrillation is 17.5%, with 26.9% of patients with valvular atrial fibrillation having a stroke and 24.2% of patients with non-valvular atrial fibrillation having a stroke. In patients with non-valvular AF, age >75 years, hypertension, diabetes mellitus and left atrial thrombus are independent risk factors for stroke development.

Concerning the treatment of atrial fibrillation, it is currently divided into pharmacological and non-pharmacological treatments. Traditional pharmacological treatments can help prevent strokes by reducing patients’ risk of forming blood clots but can cause side effects such as excessive bleeding, severe arrhythmias and even well-known complications. Catheter ablation is the primary non-pharmacological treatment for atrial fibrillation and is a representative treatment for cardiac EP (electrophysiology) techniques.

Anticoagulation therapy is an essential modality in treating atrial fibrillation at this stage and can reduce the risk of stroke by 60–70%. Commonly used anticoagulants on the market include warfarin, rivaroxaban and dabigatran.

However, not all patients with atrial fibrillation need anticoagulants, only those at high risk of stroke. The risk of stroke in patients with atrial fibrillation needs to be calculated by a doctor based on the presence of risk factors, including older age, high blood pressure, diabetes, heart failure, and a history of stroke or thromboembolism.

Thrombolytic therapy is also a bottom-up drug when a stroke occurs in atrial fibrillation patients.

Generally, atrial fibrillation is treated with anticoagulant and antithrombotic measures, but thrombolytic therapy can also be administered when atrial fibrillation progresses to pulmonary embolism or cerebral embolism. However, thrombolytic therapy also requires assessment, for example, pulmonary embolism is a critical and emergency condition, and if haemodynamic changes occur, thrombolytic therapy is required as soon as possible.

It means that thrombolysis is also available for patients with atrial fibrillation, but it is not taken lightly and maybe the ultimate “bottom-up” treatment if clinically indicated.

Specifically, atrial fibrillation can lead to thrombosis of the left atrium and the left ear, which cannot be easily thrombolised, because if it does, the thrombus will be dislodged from the left atrium or the left ear and reach the left ventricle, from where it will pass through the arterial blood to the aorta and its branches. If it reaches the cerebral vessels, it can cause a cerebral infarction, and if it reaches other vital organs, it can cause embolism of the vital organs.

Therefore if atrial fibrillation is combined with a left atrial or left ear thrombus, the first course of action is anticoagulation, either warfarin or a newer anticoagulant, low molecular heparin being one of the options. During anticoagulation, the thrombus is closely monitored for reduction by transthoracic ultrasound or trans-oesophageal ultrasound.

Suppose atrial fibrillation leads to the formation of a thrombus and its dislodgement, which can lead to a cerebral thrombus and sudden cardiac death if it reaches the heart. In this case, surgical thrombolysis is required.

As for thrombolytic drugs, the commonly used thrombolytic drugs in the market include urokinase (UK), streptokinase (SK), alteplase (rt-PA), Puyuk (Pro-UK), alteplase (r-PA) and tenecteplase (TNK-Tpa). In addition, several emerging biotech companies are also starting to address the market in the cardiovascular therapeutic area, especially in the thrombolytic therapy segment, and HKND is one of them.

Our core technology product, YB1, can be combined with various thrombolytic drugs to treat various thrombotic diseases. The three existing thrombolytic drug products under development are YB1-rt-PA, YB1-rt-DE and YB1-rt-PL. The future clinical results are worth looking forward to.

At a time when cardiovascular disease is at its peak in winter, the enthusiasm of innovative biotechnology companies in the research and development of new drugs has, to a certain extent, raised some optimism among the people of China because of the continued high incidence of cardiovascular diseases caused by arrhythmias such as atrial fibrillation. We hope that with the concerted efforts of society as a whole, the nation’s health can be effectively improved, and the prevention and treatment of arrhythmias such as atrial fibrillation can be improved. We hope that with the concerted efforts of society as a whole, the nation’s health can be effectively improved, and the prevention and treatment of arrhythmias such as atrial fibrillation can be improved to keep cardiovascular diseases at bay.

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