Antithrombotic treatment from the point of view of new guidelines for the management of atrial fibrillation
Authors:
P. Heinc; O. Moravec; J. Přeček; J. Ondrušková; M. Táborský
Authors‘ workplace:
I. interní klinika FN Olomouc
Published in:
Kardiol Rev Int Med 2011, 13(3): 153-159
Overview
Atrial fibrillation is associated with significantly greater rates of morbidity and mortality, caused primarily by thromboembolic complications. The prevention of thromboembolic strokes is therefore one of the most important elements of the complex treatment of atrial fibrillation. Different strategies for anticoagulant or antiplatelet therapy in patients with atrial fibrillation are recommended for the prevention of thromboembolic complications according to the presentation of a different number of risk factors. New guidelines optimize antithrombotic treatment according to new risk stratification (CHA2DS2Vasc score) and mentioned the future of alternative antithrombotic treatment using direct thrombin antagonists or factor Xa inhibitors.
Keywords:
antithrombotic treatment – atrial fibrillation – CHA2DS2Vasc score – direct thrombin antagonists – factor Xa inhibitors
Sources
1. Hughes M, Lip GY. Guideline Development Group. National Clinical Guideline for Management of Atrial Fibrillation in Primary and Secondary Care, National Institute for Health and Clinical Excellence. Stroke and thromboembolism in atrial fibrillation: a systematic review of stroke risk factors, risk stratification schema and cost effectiveness data. Thromb Haemost 2008; 99: 295–304.
2. Stroke in Atrial Fibrillation Working Group. Independent predictors of stroke in patients with atrial fibrillation: a systematic review. Neurology 2007; 69: 546–554.
3. Lip GY, Lim HS. Atrial fibrillation and stroke prevention. Lancet Neurol 2007; 6: 981–993.
4. Lip GY, Nieuwlaat R, Pisters R et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 2010; 137: 263–272.
5. Nieuwlaat R, Capucci A, Lip GY et al. Euro Heart Survey Investigators. Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation. Eur Heart J 2006; 27: 3018–3026.
6. Mant J, Hobbs FD, Fletcher K et al. BAFTA investigators; Midland Research Practices Network (MidReC). Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged study, BAFTA): a randomized controlled trial. Lancet 2007; 370: 493–503.
7. Lee BH, Park JS, Park JH, et al. The effect and safety of the anti-thrombotic therapies in patients with atrial fibrillation and CHADS2 score 1. J Cardiovasc Electrophysiol 2010; 21: 501–507.
8. Gorin L, Fauchier L, Nonin et al. Antithrombotic treatment and the risk of death and stroke in patients with atrial fibrillation and a CHADS2 score=1. Thromb Haemost 2010; 103: 833–840.
9. Sato H, Ishikawa K, Kitabatake A, et al. Japan Atrial Fibrillation Stroke Trial Group. Low-dose aspirin for prevention of stroke in low-risk patients with atrial fibrillation: Japan Atrial Fibrillation Stroke Trial. Stroke 2006; 37: 447–451.
10. Connolly SJ, Pogue J, Hart RG et al. ACTIVE Investigators. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 2009; 360: 2066–2078.
11. Connolly S, Pogue J, Hart RG et al. ACTIVE Writing Group of the ACTIVE Investigators. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet 2006; 367: 1903–1912.
12. Schmitt J, Duray G, Gersh BJ et al. Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. Eur Heart J 2009; 30: 1038–1045.
13. Lip GY, Halperin JL. Improving stroke risk stratification in atrial fibrillation. Am J Med 2010;123:484–488.
14. Rietbrock S, Plumb JM, Gallagher AM et al. How effective are dose-adjusted warfarin and aspirin for the prevention of stroke in patients with chronic atrial fibrillation? An analysis of the UK General Practice Research Database. Thromb Haemost 2009; 101: 527–534.
15. Tay KH, Lip GY, Lane DA. Atrial fibrillation and stroke risk prevention in real-life clinical practice. Thromb Haemost 2009; 101: 415–416.
16. Connoly SJ, Ezekowitz MD, Yusuf S, et al. RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361: 1139–1151.
17. Mant J, Hobbs FD, Fletcher K, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet 2007; 370: 493–503.
18. Pisters R, Lane DA, Nieuwlaat R et al. A novel userfriendly score (HAS-BLED) to assess one-year risk of major bleeding in patients with atrial fibrillation: The Euro Heart Survey. Chest 2010; 138: 1093–1100.
19. Buresly K, Eisenberg MJ, Zhang X et al. Bleeding complications associated with combinations of aspirin, thienopyridine derivatives, and warfarin in elderly patients following acute myocardial infarction. Arch Intern Med 2005; 165: 784–789.
20. Porter A, Konstantino Y, Iakobishvili Z et al. Short-term triple therapy with aspirin, warfarin, and a thienopyridine among patients undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2006; 68: 56–61.
21. Vicenzi MN, Meislitzer T, Heitzinger B, et al. Coronary artery stenting and non-cardiac surgery: a prospective outcome study. Br J Anaesth 2006; 96: 686–693.
22. Grines CL, Bonow RO, Casey DE Jr et al. American Heart Association; American College of Cardiology; Society for Cardiovascular Angiography and Interventions; American College of Surgeons; American Dental Association; American College of Physicians. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: A science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. J Am Coll Cardiol 2007; 49: 734–739.
23. Brilakis ES, Banerjee S, Berger PB. Perioperative management of patients with coronary stents. J Am Coll Cardiol 2007; 49: 2145–2150.
24. Lip GY, Huber K, Andreotti F et al. European Society of Cardiology Working Group on Thrombosis. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary intervention/stenting. Thromb Haemost 2010; 103: 13–28.
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Paediatric cardiology Internal medicine Cardiac surgery CardiologyArticle was published in
Cardiology Review
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