atrial fibrillation and stroke prevention - Continuing Medical ...
atrial fibrillation and stroke prevention - Continuing Medical ... atrial fibrillation and stroke prevention - Continuing Medical ...
Essentials in Primary Care Conference Wednesday, July 31, 2013 Contrasting the 3 New Oral Agents • Apixaban prevents about 3 more strokes per 1000 patients per year than warfarin. Plus it leads to 10 FEWER bleeds and 4 FEWER deaths. • Rivaroxaban doesn’t prevent more strokes than warfarin...and has a similar risk of bleeding. But it’s the only new agent given just ONCE daily. • Dabigatran prevents about 5 more strokes per 1000 patients per year than warfarin...with a similar overall bleeding risk. Dabigatran is also the only new agent that reduces ISCHEMIC strokes compared to warfarin...in addition to HEMORRHAGIC strokes. Pharmacists/Physicians Letter Feb 2013. Optimal Candidates for Warfarin Patients who: • Have (borderline) renal insufficiency • Are taking stable dose of warfarin and do not find INR testing burdensome • Have access to self-testing machine or other reliable means of regular INR monitoring • Are concerned about the lack of an evidencebased reversal strategy • Has issues with out-of-pocket expense Jan Basile, MD Atrial Fibrillation & Stroke Prevention
Essentials in Primary Care Conference Wednesday, July 31, 2013 Optimal Candidates for New Oral Antithrombotic Drugs Patients who: • Find INR testing burdensome • Despite adherence to provider recommendations, have low INR ‘time-inrange’ (TTR) • Can afford (or arrange to get) the new drugs • Have normal and stable renal function AF Rx as Per CHADS 2 Score: AT8 (2008) vs AT9 (2012) CHADS 2 0 Rx Recommendation AT8 (2008) AT9 (2012) ASA No Rx (2B) 1 >2 Warfarin or ASA Warfarin Oral Anticoagulant (1B) Oral Anticoagulant (1A) You JJ, et al. CHEST 2012;141(2)(Suppl):e531S-e575S Jan Basile, MD Atrial Fibrillation & Stroke Prevention
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Essentials in Primary Care Conference<br />
Wednesday, July 31, 2013<br />
Optimal C<strong>and</strong>idates for New<br />
Oral Antithrombotic Drugs<br />
Patients who:<br />
• Find INR testing burdensome<br />
• Despite adherence to provider<br />
recommendations, have low INR ‘time-inrange’<br />
(TTR)<br />
• Can afford (or arrange to get) the new drugs<br />
• Have normal <strong>and</strong> stable renal function<br />
AF Rx as Per CHADS 2 Score:<br />
AT8 (2008) vs AT9 (2012)<br />
CHADS 2<br />
0<br />
Rx Recommendation<br />
AT8 (2008) AT9 (2012)<br />
ASA<br />
No Rx (2B)<br />
1<br />
>2<br />
Warfarin or ASA<br />
Warfarin<br />
Oral Anticoagulant<br />
(1B)<br />
Oral Anticoagulant<br />
(1A)<br />
You JJ, et al. CHEST 2012;141(2)(Suppl):e531S-e575S<br />
Jan Basile, MD<br />
Atrial Fibrillation & Stroke Prevention
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