Current management of atrial fibrillation

Samardhi, H.; Santos, Maria José; Denman, R.; Walters, D.; Bett, Nicholas

doi:10.18773/austprescr.2011.058

Cited by 5 publications

(4 citation statements)

References 37 publications

(36 reference statements)

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“…When determining who should receive anticoagulation, a risk‐stratification model is used. The rationale behind risk stratification is that although anticoagulation has clearly been shown to be more effective than antiplatelet agents or placebos in the prevention of thromboembolic stroke, their use should be restricted to patients whose risk for a thromboembolic event exceeds their risk of hemorrhage [11–13]. Risk factors for thromboembolic events in nonvalvular AF include a history of stroke, diabetes mellitus, hypertension, heart failure, and age.…”

Section: Introductionmentioning

confidence: 99%

“…These were incorporated into the initial score called CHADS 2 [6,14]. The annual risk of stroke increased incrementally from 2%, with a score of 0, to as high as 22%, with a score of 6, in the absence of anticoagulant therapy [11,15,16]. A second score known as CHA 2 DS 2 ‐VASc was developed to further delineate the risk in the perceived low‐risk groups using additional risk factors [6,17,18].…”

Section: Introductionmentioning

confidence: 99%

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Management of antithrombotic therapy during cardiac implantable device surgery

AlTurki

Proietti

Birnie

et al. 2016

Journal of Arrhythmia

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Anticoagulants are commonly used drugs that are frequently encountered during device placement. Deciding when to halt or continue the use of anticoagulants is a balance between the risks of thromboembolism versus bleeding. Patients taking warfarin with a high risk of thromboembolism should continue to take their warfarin without interruption during device placement while ensuring their international normalized ratio remains below 3. For patients who are taking warfarin and have low risk of thromboembolism, either interrupted or continued warfarin may be used, with no evidence to clearly support either strategy. There is little evidence to support continuing direct acting oral anticoagulants (DOACs) for device implantation. The timing of halting these medications depends largely on renal function. If bleeding occurs, warfarin׳s anticoagulation effect is reversible with vitamin K and activated prothrombin complex concentrate. There are no DOAC reversal agents currently available, but some are under development. Regarding antiplatelet agents, aspirin alone can be safely continued while clopidogrel alone may also be continued, but with a slightly higher bleeding risk. Dual antiplatelet therapy for bare-metal stent/drug-eluting stent implanted within 4 weeks/6 months, respectively, should be continued due to high risk of stent thrombosis; however, if they are implanted after this period, then clopidogrel can be halted 5 days before the procedure and resumed soon after, while aspirin is continued. If the patient is taking both aspirin and warfarin, aspirin should be halted 5 days prior to the procedure, while warfarin is continued.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of antithrombotic therapy during cardiac implantable device surgery

AlTurki

Proietti

Birnie

et al. 2016

Journal of Arrhythmia

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“…Atrial fibrillation (AF) is a common sustained cardiac arrhythmia [1][2][3][4] with an estimated prevalence of 0.5 to 2% in Western countries [5]. Globally it is projected that cases of AF will double by 2050 with an associated increase in hospitalisations [4].…”

Section: Introductionmentioning

confidence: 99%

Anticoagulant Initiation During Hospital Admissions for Atrial Fibrillation in South-East Queensland, Australia

Rathinam

Anoopkumar‐Dukie

Badrick

et al. 2020

Heart, Lung and Circulation

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BACKGROUNDAnticoagulation reduces stroke risk in patients with atrial fibrillation (AF) but underprescribing in eligible patients has been commonly reported. Introduction of the direct acting oral anticoagulants (DOACs) was considered to potentially improve prescribing due to increased anticoagulant options. At the time of release to the Australian market, there was limited studies investigating anticoagulant usage during hospitalisations for AF. Therefore, the aim of this study was to investigate prescribing of oral anticoagulants during hospitalisations admissions for AF during the time of DOAC introduction to the Australian market. METHODA retrospective study was conducted of admissions to a tertiary Queensland hospital during 1 July 2012 to 10 June 2015. Patients were categorised according to oral anticoagulant therapy on both hospital admission and discharge. Changes to therapy and patient factors associated with prescribing were analysed. RESULTSA total of 1911 patients were included with 3396 admissions during the study period. There was a significant increase in the number of patients initiated on anticoagulant therapy during their first admission with higher rates of initiation of DOACs compared to warfarin.Ischaemic heart disease and high bleed risk were significantly associated with reduced prescribing of anticoagulant therapy on first and second admission respectively, while patients with history of stroke or transient ischaemic attack were significantly more likely to receive therapy. CONCLUSIONThe introduction of the DOACs to the Australian market increased initiation of anticoagulants to hospitalised patients with AF across all stroke risk categories. The availability of greater anticoagulant options has increased initiation of therapy but there remains potential to further optimise anticoagulant prescribing by targeting therapy according to guidelines and patient factors.

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“…Das Risiko einen ischämen Schlaganfall zu erleiden ist 5-fach erhöht [3]. Aufgrund des hohen thromboembolischen Risikos umfasst die therapeutische Behandlung des Vorhofflimmerns neben der Kontrolle der Herzfrequenz auch die antithrombotische Prophylaxe [4]. Über 5 Jahrzehnte waren die beiden oralen Antikoagulantien Warfarin (Coumadin ® ) und Phenprocoumon (Marcumar ® ) der Goldstandard in der Prophylaxe thromboembolischer Ereignisse bei Vorhofflimmern.…”

Section: Introductionunclassified

Kosteneffektivität von Apixaban zur Verhinderung von Schlaganfällen bei Vorhofflimmern in Deutschland

Reimer

Schöffski

2013

PharmacoEcon. Ger. Res. Artic.

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Background and Objective: Apixaban was shown to be superior to warfarin and acetylsalicylic acid in preventing stroke in patients with atrial fibrillation and at least one additional risk factor. This study compared the cost effectiveness of apixaban versus warfarin and acetylsalicylic acid in this patient population in Germany. Methods: We constructed a lifetime Markov model with 12 health states, based on the results of the Aristotle and Averroes trial, to evaluate the cost effectiveness of apixaban from the social healthcare perspective. Our base-case assumed a cohort of 65-year old patients with a CHADS 2 Score of 2.1. We used a 1-month cycle-length. The outcome was measured in quality-adjusted life-years (QALYs), costs and incremental-cost-effectiveness ratios (ICER). The robustness of the model was tested with one and two way sensitivity analyses. A probabilistic sensitivity analysis was also performed. Results: Under base case conditions, total costs per patient were € 33,427 and € 33,118 for apixaban and warfarin. Corresponding QALYs were 10.79 and 10.06 in the lifetime Markov model. The ICER was € 423 per QALY. Monte Carlo simulation demonstrated apixaban was cost-effective in 86 % and

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Current management of atrial fibrillation

Cited by 5 publications

References 37 publications

Management of antithrombotic therapy during cardiac implantable device surgery

Management of antithrombotic therapy during cardiac implantable device surgery

Anticoagulant Initiation During Hospital Admissions for Atrial Fibrillation in South-East Queensland, Australia

Kosteneffektivität von Apixaban zur Verhinderung von Schlaganfällen bei Vorhofflimmern in Deutschland

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