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 products or medical devices

Learning Objectives

Atrial Fibrillation (AF): Incidence and Consequences

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

AF and Stroke

Greater Risk of Death and Recurrence With AF Strokes

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

Assessing Benefits and Risks Anticoagulation:

Question

Case 1

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

Weakness of CHADS 2

The CHA 2 DS 2 -VASc Index

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

Case 2

ACC/AHA/ESC Guidelines

Risk Stratification and Anticoagulation

Underuse of Anticoagulants in AF Systematic review of 54 studies

Barriers to Anticoagulant Use

Barriers to Anticoagulation?

Bleeding Risk

Bleeding Risk: The Reality

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

Assessing Bleeding Risk: HAS-BLED

Reducing Bleeding Risk

Decision Support Anticoagulation Worksheet

Anticoagulation Decision Support Worksheet (cont.)

The Patient: Decision Making and Education

Patient vs Physician Perspectives on Anticoagulation

Explaining Risk to Patients: Numerous Tools Available

Patient Knowledge About Warfarin

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

Risk Factors for Warfarin Nonadherence

Improving Patient Adherence to Anticoagulants

Which Antithrombotic Therapy?

Generic/Trade Name Guide for Drugs Mentioned in Presentation

Features of Available Anticoagulants

Warfarin and Novel Anticoagulant Mechanisms of Action

Choosing an Anticoagulant

Question Check

Clopidogrel and/or Aspirin?

ACC/AHA/ESC Guidelines: Warfarin vs Aspirin

Warfarin: The Gold Standard

Currently Available Oral Anticoagulants

Clinical Trial Data

Limitations/Concerns With Available Anticoagulants

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

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

Drug-Specific Guidelines for Managing Through Medical Procedures

When to Switch From Warfarin

Remain With Warfarin if …

Switching From Warfarin: How?

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

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