improving stroke prevention in patients with atrial
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Improving Stroke Prevention in Patients With Atrial Fibrillation Acknowledgement Disclosures Disclosures (cont.) Dr. John Kylan Lynch has no disclosures This presentation will not include any non-FDA approved or investigational uses of

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  1. Improving Stroke Prevention in Patients With Atrial Fibrillation

  2. Acknowledgement

  3. Disclosures

  4. Disclosures (cont.) • Dr. John Kylan Lynch has no disclosures • This presentation will not include any non-FDA approved or investigational uses of products or medical devices

  5. Learning Objectives

  6. Atrial Fibrillation (AF): Incidence and Consequences

  7. Projected Number of Persons With AF in the US: 2000 to 2050 Atrial Fibrillation has a high public health burden

  8. AF and Stroke

  9. Greater Risk of Death and Recurrence With AF Strokes

  10. Disability vs Age Group in Those With Acute Ischemic Stroke (AIS) vs AF-AIS Cardioembolic strokes are more disabling than non ‐ cardioembolic strokes

  11. Assessing Benefits and Risks Anticoagulation:

  12. Question

  13. Case 1

  14. CHADS 2 Index: A Validated Classification Scheme/Tool for Stroke Risk Based on 1733 Medicare Beneficiaries with AF who did not receive Warfarin at discharge

  15. Weakness of CHADS 2

  16. The CHA 2 DS 2 -VASc Index

  17. CHA 2 DS 2 -VASc vs CHADS 2 : Which to Use?

  18. Case 2

  19. ACC/AHA/ESC Guidelines

  20. Risk Stratification and Anticoagulation

  21. Underuse of Anticoagulants in AF Systematic review of 54 studies

  22. Barriers to Anticoagulant Use

  23. Barriers to Anticoagulation?

  24. Bleeding Risk

  25. Bleeding Risk: The Reality

  26. Anticoagulation in Patients at Risk of Falls: “Physicians’ Fears Are Often Unfounded”

  27. Assessing Bleeding Risk: HAS-BLED

  28. Reducing Bleeding Risk

  29. Decision Support Anticoagulation Worksheet

  30. Anticoagulation Decision Support Worksheet (cont.)

  31. The Patient: Decision Making and Education

  32. Patient vs Physician Perspectives on Anticoagulation

  33. Explaining Risk to Patients: Numerous Tools Available

  34. Patient Knowledge About Warfarin

  35. Patient Adherence to Warfarin Adherence worsened than improved after Non ‐ adherent ~ 21% of time in 1 st year 6 months

  36. Risk Factors for Warfarin Nonadherence

  37. Improving Patient Adherence to Anticoagulants

  38. Which Antithrombotic Therapy?

  39. Generic/Trade Name Guide for Drugs Mentioned in Presentation

  40. Features of Available Anticoagulants

  41. Warfarin and Novel Anticoagulant Mechanisms of Action

  42. Choosing an Anticoagulant

  43. Question Check

  44. Clopidogrel and/or Aspirin?

  45. ACC/AHA/ESC Guidelines: Warfarin vs Aspirin

  46. Warfarin: The Gold Standard

  47. Currently Available Oral Anticoagulants

  48. Clinical Trial Data

  49. Limitations/Concerns With Available Anticoagulants

  50. Visit TEAManticoag.com for a Medication Chart (Keyword: chart)

  51. ACC/AHA/ESC Guidelines: Managing Through Medical Procedures to Prevent Thrombosis

  52. Drug-Specific Guidelines for Managing Through Medical Procedures

  53. When to Switch From Warfarin

  54. Remain With Warfarin if …

  55. Switching From Warfarin: How?

  56. AHA Guidelines : Secondary Stroke Prevention AHA Recommendations (2012) ‐ Updates Indication Treatment options Stroke/TIA + AF Warfarin, dabigatran, apixiban, rivaroxaban Stroke/TIA + AF + renal failure Dabigatran (75 mg) or rivaroxaban (15 mg) (CrCL 15 ‐ 30 mL/min) Stroke/TIA + AF + renal failure Rivaroxaban, dabigatran, and apixiban NOT (CrCL <15 mL/min) recommended Stroke/TIA + AF + unable to take ASA, apixiban, ASA + Plavix may be considered anticoagulants

  57. Visit TEAManticoag.com for Tools, Handouts, Calculators, and More

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