atrial fibrillation and stroke prevention - Continuing Medical ...
atrial fibrillation and stroke prevention - Continuing Medical ...
atrial fibrillation and stroke prevention - Continuing Medical ...
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Essentials in Primary Care Conference<br />
Wednesday, July 31, 2013<br />
Canadian Cardiovascular Society<br />
Guidelines<br />
Assess Thromboembolic Risk<br />
(CHADS 2 )<br />
CHADS 2 = 0<br />
CHADS 2 = 1<br />
CHADS 2 = 2<br />
Increasing <strong>stroke</strong> risk<br />
No antithrombotic<br />
ASA<br />
OAC*<br />
OAC*<br />
OAC<br />
No<br />
additional<br />
risk factors<br />
for <strong>stroke</strong><br />
Either<br />
female sex<br />
or<br />
vascular<br />
disease<br />
Age 65 yrs<br />
Age > or 65 yrs<br />
combination<br />
or<br />
combination<br />
female<br />
female sex<br />
sex<br />
+ vascular <strong>and</strong><br />
vascular disease<br />
disease<br />
*ASA is a<br />
reasonable<br />
alternative<br />
for some as<br />
indicated by<br />
risk/benefit<br />
When OAC therapy is<br />
indicated, most patients<br />
receive:<br />
• Dabigatran, rivaroxaban,<br />
or apixaban (after Health<br />
Canada approval)<br />
• In preference to warfarin<br />
• Conditional Recommendation,<br />
High-Quality Evidence<br />
Skanes AC, et al. Can J Cardiol. 2012 Mar-Apr;28(2):125-36..<br />
Take-home Teaching Points:<br />
• Most patients with CHADS 2 > 2 will derive net benefit<br />
from anticoagulation, regardless of ‘bleeding score’<br />
• For patients with CHADS 2 = 0 or 1<br />
Consider calculating CHA 2 DS 2 -VASc score<br />
If CHA 2 DS 2 -VASc score is 1 or higher, anticoagulate<br />
but….<br />
Weigh absolute benefit of AC against best estimate<br />
of bleeding risk<br />
• Antiplatelet therapy (e.g. ASA <strong>and</strong>/or clopidogrel) is<br />
much less effective than anticoagulation (<strong>and</strong> not<br />
significantly safer!)<br />
Jan Basile, MD<br />
Atrial Fibrillation & Stroke Prevention
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