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Improving Stroke Prevention in Patients With Atrial Fibrillation - - PowerPoint PPT Presentation
Improving Stroke Prevention in Patients With Atrial Fibrillation - - PowerPoint PPT Presentation
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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Disclosures
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Disclosures (cont.)
- Dr. John Kylan Lynch has no disclosures
- This presentation will not include any
non-FDA approved or investigational uses
- f products or medical devices
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Learning Objectives
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Atrial Fibrillation (AF): Incidence and Consequences
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Projected Number of Persons With AF in the US: 2000 to 2050
Atrial Fibrillation has a high public health burden
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AF and Stroke
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Greater Risk of Death and Recurrence With AF Strokes
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Disability vs Age Group in Those With Acute Ischemic Stroke (AIS) vs AF-AIS
Cardioembolic strokes are more disabling than non‐cardioembolic strokes
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Anticoagulation: Assessing Benefits and Risks
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Question
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Case 1
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CHADS2 Index: A Validated Classification Scheme/Tool for Stroke Risk
Based on 1733 Medicare Beneficiaries with AF who did not receive Warfarin at discharge
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Weakness of CHADS2
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The CHA2DS2-VASc Index
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CHA2DS2-VASc vs CHADS2: Which to Use?
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Case 2
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ACC/AHA/ESC Guidelines
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Risk Stratification and Anticoagulation
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Underuse of Anticoagulants in AF
Systematic review of 54 studies
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Barriers to Anticoagulant Use
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Barriers to Anticoagulation?
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Bleeding Risk
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Bleeding Risk: The Reality
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Anticoagulation in Patients at Risk of Falls: “Physicians’ Fears Are Often Unfounded”
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Assessing Bleeding Risk: HAS-BLED
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Reducing Bleeding Risk
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Anticoagulation Decision Support Worksheet
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Anticoagulation Decision Support Worksheet (cont.)
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The Patient: Decision Making and Education
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Patient vs Physician Perspectives
- n Anticoagulation
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Explaining Risk to Patients: Numerous Tools Available
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Patient Knowledge About Warfarin
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Patient Adherence to Warfarin
Adherence worsened than improved after 6 months Non‐adherent ~ 21% of time in 1st year
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Risk Factors for Warfarin Nonadherence
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Improving Patient Adherence to Anticoagulants
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Which Antithrombotic Therapy?
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Generic/Trade Name Guide for Drugs Mentioned in Presentation
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Features of Available Anticoagulants
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Warfarin and Novel Anticoagulant Mechanisms of Action
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Choosing an Anticoagulant
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Question Check
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Clopidogrel and/or Aspirin?
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ACC/AHA/ESC Guidelines: Warfarin vs Aspirin
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Warfarin: The Gold Standard
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Currently Available Oral Anticoagulants
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Clinical Trial Data
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Limitations/Concerns With Available Anticoagulants
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Visit TEAManticoag.com for a Medication Chart (Keyword: chart)
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ACC/AHA/ESC Guidelines: Managing Through Medical Procedures to Prevent Thrombosis
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Drug-Specific Guidelines for Managing Through Medical Procedures
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When to Switch From Warfarin
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Remain With Warfarin if …
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Switching From Warfarin: How?
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AHA Guidelines : Secondary Stroke Prevention
AHA Recommendations (2012) ‐ Updates
Indication Treatment options Stroke/TIA + AF Warfarin, dabigatran, apixiban, rivaroxaban Stroke/TIA + AF + renal failure (CrCL 15‐30 mL/min) Dabigatran (75 mg) or rivaroxaban (15 mg) Stroke/TIA + AF + renal failure (CrCL <15 mL/min) Rivaroxaban, dabigatran, and apixiban NOT recommended Stroke/TIA + AF + unable to take anticoagulants ASA, apixiban, ASA + Plavix may be considered
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