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 Canadian Cardiovascular Society Guidelines Assess Thromboembolic Risk (CHADS 2 ) CHADS 2 = 0 CHADS 2 = 1 CHADS 2 = 2 Increasing stroke risk No antithrombotic ASA OAC* OAC* OAC No additional risk factors for stroke Either female sex or vascular disease Age 65 yrs Age > or 65 yrs combination or combination female female sex sex + vascular and vascular disease disease *ASA is a reasonable alternative for some as indicated by risk/benefit When OAC therapy is indicated, most patients receive: • Dabigatran, rivaroxaban, or apixaban (after Health Canada approval) • In preference to warfarin • Conditional Recommendation, High-Quality Evidence Skanes AC, et al. Can J Cardiol. 2012 Mar-Apr;28(2):125-36.. Take-home Teaching Points: • Most patients with CHADS 2 > 2 will derive net benefit from anticoagulation, regardless of ‘bleeding score’ • For patients with CHADS 2 = 0 or 1 Consider calculating CHA 2 DS 2 -VASc score If CHA 2 DS 2 -VASc score is 1 or higher, anticoagulate but…. Weigh absolute benefit of AC against best estimate of bleeding risk • Antiplatelet therapy (e.g. ASA and/or clopidogrel) is much less effective than anticoagulation (and not significantly safer!) Jan Basile, MD Atrial Fibrillation & Stroke Prevention
Essentials in Primary Care Conference Wednesday, July 31, 2013 Take Home Teaching Points • Stroke risk reduction with warfarin is substantial (±66%) • Risk of ICH with warfarin is low (
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Essentials in Primary Care Conference<br />
Wednesday, July 31, 2013<br />
Canadian Cardiovascular Society<br />
Guidelines<br />
Assess Thromboembolic Risk<br />
(CHADS 2 )<br />
CHADS 2 = 0<br />
CHADS 2 = 1<br />
CHADS 2 = 2<br />
Increasing <strong>stroke</strong> risk<br />
No antithrombotic<br />
ASA<br />
OAC*<br />
OAC*<br />
OAC<br />
No<br />
additional<br />
risk factors<br />
for <strong>stroke</strong><br />
Either<br />
female sex<br />
or<br />
vascular<br />
disease<br />
Age 65 yrs<br />
Age > or 65 yrs<br />
combination<br />
or<br />
combination<br />
female<br />
female sex<br />
sex<br />
+ vascular <strong>and</strong><br />
vascular disease<br />
disease<br />
*ASA is a<br />
reasonable<br />
alternative<br />
for some as<br />
indicated by<br />
risk/benefit<br />
When OAC therapy is<br />
indicated, most patients<br />
receive:<br />
• Dabigatran, rivaroxaban,<br />
or apixaban (after Health<br />
Canada approval)<br />
• In preference to warfarin<br />
• Conditional Recommendation,<br />
High-Quality Evidence<br />
Skanes AC, et al. Can J Cardiol. 2012 Mar-Apr;28(2):125-36..<br />
Take-home Teaching Points:<br />
• Most patients with CHADS 2 > 2 will derive net benefit<br />
from anticoagulation, regardless of ‘bleeding score’<br />
• For patients with CHADS 2 = 0 or 1<br />
Consider calculating CHA 2 DS 2 -VASc score<br />
If CHA 2 DS 2 -VASc score is 1 or higher, anticoagulate<br />
but….<br />
Weigh absolute benefit of AC against best estimate<br />
of bleeding risk<br />
• Antiplatelet therapy (e.g. ASA <strong>and</strong>/or clopidogrel) is<br />
much less effective than anticoagulation (<strong>and</strong> not<br />
significantly safer!)<br />
Jan Basile, MD<br />
Atrial Fibrillation & Stroke Prevention
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