atrial fibrillation and stroke prevention - Continuing Medical ...

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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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