scholarly journals ANTICOAGULATION BEFORE AND AFTER CARDIOVERSION OR ABLATION. CHALLENGES, PROBLEMS AND MISTAKES

2021 ◽  
Vol 31 (1) ◽  
pp. 65-70
Author(s):  
Agnė Česnauskaitė ◽  
Andrius Montrimas ◽  
Diana Rinkūnienė ◽  
Aras Puodžiukynas
Keyword(s):  
Atrial Fibrillation ◽  
Statistical Analysis ◽  
Catheter Ablation ◽  
Anticoagulant Therapy ◽  
European Society ◽  
Oral Anticoagulants ◽  
Limited Data ◽  
Before And After ◽  
Esc Guidelines ◽  
European Society Of Cardiology

Background: Limited data exists addressing the daily use of anticoagulants for atrial fibrillation (AF) and atrial flutter (AFL) patients before and after electrical cardioversion (ECV) or catheter ablation procedures. The purpose of the study was to evaluate the appropriateness of anticoagulant therapy. Methods: We evaluated the prescribed dosage of anticoagulant therapy for 257 non-valvular AF and AFL patients scheduled for ECV or catheter ablation and the appropriateness of periprocedural anticoagulation according to European Society of Cardiology (ESC) AF Guidelines. The statistical analysis was performed using IBM SPSS Statistics software (v.26.0). Results: The majority of the patients (84%) used nonvitamin K antagonist oral anticoagulants (NOACs) for pre-procedural anticoagulation. An intervention was not performed for 12.2% of warfarin users because of insufficient hypocoagulation, while anamnesis of patients’ missed doses with a possibility of inadequate hypocoagulation occurred only in 1.9% of patients on NOACs. The odds of having insufficient pre-procedural hypocoagulation were 7.4 times higher for warfarin users compared to the NOACs group (p=0.001, OR=7.4). An incorrect NOAC dose was assigned to 22 (8.6%) patients. Rivaroxaban was the most prescribed NOAC and this group of patients had the highest percentage of incorrect dosage according to the ESC guidelines. Conclusions: Mistakes of prescribing the dosage of anticoagulant therapy are common. The majority of the patients in the study were prescribed with NOACs before and after ECV or catheter ablation procedures. Warfarin users had higher odds of the intervention not being performed and not reaching sufficient hypocoagulation prior to the procedure compared to NOACs users.

scholarly journals Contemporary Management of Stroke Prevention in Atrial Fibrillation Following the European Society of Cardiology Guidelines

2017 ◽  
Vol 12 (1) ◽  
pp. 38 ◽  
Author(s):  
Manav Sohal ◽  
Keyword(s):  
Atrial Fibrillation ◽  
European Society ◽  
Oral Anticoagulants ◽  
Coronary Intervention ◽  
Thromboembolic Complications ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Esc Guidelines ◽  
Contemporary Management ◽  
European Society Of Cardiology

The recent publication of the European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation provides a timely update at a time when the rapid uptake of non-vitamin K antagonist oral anticoagulants has changed the landscape of clinical practice. Several key changes have been highlighted, including better identification of those deemed to be low risk for thromboembolic complications and a more standardised approach to patients with atrial fibrillation who require concomitant antiplatelet therapy following either percutaneous coronary intervention or an acute coronary syndrome. This article distils the key messages from the ESC guidelines and draws the reader’s attention to both gaps and advances in our knowledge.

scholarly journals Aspects of anticoagulant therapy in patients with atrial fibrillation in the light of updated guidelines of the European society of cardiology 2020: the position of dabigatran

2020 ◽  
pp. 17-26
Author(s):  
E. S. Kropacheva ◽  
E. P. Panchenko
Keyword(s):  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
European Society ◽  
Treatment Strategy ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Integrated Approach ◽  
Risk Of Bleeding ◽  
European Society Of Cardiology

This review focuses on some aspects of anticoagulant therapy in the updated clinical guidelines for atrial fibrillation of the European society of cardiology, published in 2020. Atrial fibrillation is a polymorbid continuously developing syndrome, and therefore the treatment strategy is based on a comprehensive assessment of the patient, including the risk of stroke, the presence and severity of symptoms, and an assessment of structural heart disease and comorbidities. The review describes the principles of the proposed integrated approach, abbreviated “ABC pathway”, as reflecting the three main directions of the treatment strategy. According to experts, the clinical picture of AF (i.e. first detected, paroxysmal, persistent, long-term persistent or permanent) should not determine the indications for the appointment of anticoagulant therapy. The CHA2DS2-VASc scale continues to be the basis for stratification of thromboembolic risk. The role of dabigatran in primary and secondary prevention of stroke and systemic embolism in patients with atrial fibrillation is described. Changes in the position of experts regarding the assessment of bleeding risk are highlighted in order to help identify unmodified and eliminate modifiable risk factors for bleeding, as well as to identify AF patients who are potentially at high risk of bleeding for more frequent monitoring and monitoring of their condition. Questions about the use of direct oral anticoagulants in the choice of rhythm control tactics are highlighted separately. The use of dabigatran in patients undergoing cardioversion and catheter ablation is justified. Practical questions about the continuous strategy of anticoagulant therapy during ablation are highlighted separately. Changes related to multicomponent therapy after percutaneous coronary intervention are highlighted. The main measure to improve the safety of combined antithrombotic therapy is to minimize the duration of triple therapy. The updated recommendations supportlimiting the duration of triple antithrombotic therapy to 1 month, and also provide for early discontinuation of aspirin (≤1 week) and continuation of double antithrombotic therapy in cases of uncomplicated stenting and low risk of thrombosis, or when the risk of bleeding exceeds the risk of thrombotic events.

scholarly journals Dabigatran in the ischemic patient undergoing atrial fibrillation ablation

ABOUTOPEN ◽  
2018 ◽  
Vol 4 (1) ◽  
pp. 154-157
Author(s):  
Roberto Spoladore
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Anticoagulant Therapy ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Poor Response ◽  
Rf Ablation ◽  
Ablation Procedure ◽  
Total Period ◽  
Hemorrhagic Events

Trans-catheter ablation of atrial fibrillation (AF) is a common treatment for symptomatic AF. Among the major complications of AF ablation are stroke, transient ischemic attacks and peri-procedural cardiac tamponade. Various clinical trials have shown that uninterrupted treatment with vitamin K antagonists (VKA) is associated with a lower incidence of embolic events compared to discontinuation of therapy; until recently, in the absence of equally solid evidence, this practice was not extended to the new oral anticoagulants (NOAC) not VKA due to the fear of hemorrhagic complications potentially associated with the use of an "irreversible" anticoagulant. The case of a patient suffering from numerous comorbidities is reported here. In light of the poor response to anti-arrhythmics, a TC-RF ablation was performed, with suspension of dabigatran administration only on the day of the procedure (for a total period <24 hours). Although the fear of the risk of bleeding potentially associated with the trans-catheter ablation procedure may still induce clinicians to stop anticoagulant therapy, even the decision to discontinue anticoagulant therapy with dabigatran on the day of surgery alone is challenged by recent evidence in the literature supporting the efficacy of dabigatran in reducing the incidence of hemorrhagic events during and after ablation, including the results of the RE-CIRCUIT study (Cardiology)

scholarly journals 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation: what is new for neurologists?

2021 ◽  
Vol 27 (1) ◽  
pp. 7-15
Author(s):  
S. N. Yanishevskiy ◽  
I. B. Skiba ◽  
A. Y. Polushin
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Anticoagulant Therapy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cryptogenic Stroke ◽  
Original Position ◽  
Diagnosis And Management ◽  
Esc Guidelines ◽  
European Society Of Cardiology

Clinical practice guidelines for the diagnosis and management of atrial fibrillation (AF) are one of the most regularly updated documents by the European Society of Cardiology. The new version of clinical practice guidelines (2020) contains a number of changes regarding anticoagulant therapy in patients with AF who have developed acute cerebrovascular accidents. In this review, we discuss the statements of the updated document on the timing of the start/restart of anticoagulant therapy after ischemic stroke and intracranial hemorrhage in patients with AF, the choice of antithrombotic therapy in patients with cryptogenic stroke, as well as the need for the additional testing to clarify the origin of the embolism. We provide our original position on the possibility of applying these recommendations to the real clinical practice.

Prevention of Thromboembolism in Atrial Fibrillation Patients

2011 ◽  
Vol 7 (1) ◽  
pp. 37
Author(s):  
Nadzeya Kuzniatsova ◽  
Gregory YH Lip ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Absolute Risk ◽  
Oral Anticoagulants ◽  
Individual Risk ◽  
Thromboembolic Events ◽  
Thromboembolic Complications ◽  
Esc Guidelines ◽  
European Society Of Cardiology ◽  
Substantial Morbidity

Atrial fibrillation is the most common sustained cardiac arrhythmia and is associated with substantial morbidity and mortality, particularly due to thromboembolic complications. Antithrombotic therapy reduces the risk of stroke and other thromboembolic events, with the greatest benefit seen in individuals at the highest absolute risk of stroke. There is increasing recognition of the superiority of oral anticoagulation over antiplatelet therapy for stroke prevention in atrial fibrillation. Nevertheless, oral anticoagulation is underused, especially in elderly people, which may in part be explained by uncertainty in the assessment of both risk of stroke and bleeding in an individual patient. The new European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation, which have recently been updated, recommend a risk-factor-based approach to thromboprophylaxis in patients with atrial fibrillation and provide practical tools for the assessment of individual risk. In this article we summarise strategies for prevention of thromboembolism in patients with atrial fibrillation as recommended by the ESC guidelines. New oral anticoagulants are also discussed.

scholarly journals Utilization of Anticoagulants in Nonvalvular Atrial Fibrillation Before and After Catheter Ablation at Shanghai, China

2019 ◽  
Vol 25 ◽  
pp. 107602961982626
Author(s):  
Chen Tingting ◽  
Wang Yuzhu ◽  
Zhang Lin ◽  
Li Ran ◽  
Li Jing ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Antithrombotic Therapy ◽  
Stroke Risk ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Utilization Rate ◽  
Prescription Data ◽  
Nonvalvular Atrial Fibrillation ◽  
Before And After

Both vitamin K antagonists (VKAs) and novel oral anticoagulants (NOACs) are effective for stroke prevention in nonvalvular atrial fibrillation (NVAF) patients. This study evaluated the utilization of VKA and NOACs in NVAF patients before and after catheter ablation in China. Prescription data were retrospectively collected between January 1, 2016, and December 31, 2016, including indication of use, dose, renal function, and risk assessment (CHA2DS2-VASc score and HAS-BLED score) in Zhongshan Hospital of Fudan University. Trends and factors associated with anticoagulants use before and after ablation were evaluated. A total of 475 patients with NVAF who received ablation were included in the analysis. Of all, 53.26% of them received antithrombotic therapy preablation. Warfarin was prescribed in 35.26%, with NOACs in 11.37%. Four hundred seventy-three patients received antithrombotic therapy (99.58%) postablation, 236 patients with NOACs (49.68%). CHA2DS2-VASc score, HAS-BLED score, hypertension, diabetes mellitus, and alcohol were independently associated with anticoagulant utilization before catheter ablation. The higher CHA2DS2-VASc score was associated with less frequent prescription of NOACs postablation. The preablation anticoagulation use was still inadequate in China, and CHA2DS2-VASc score was a significant factor influencing the preablation anticoagulant utilization. The utilization rate of NOACs increased significantly postablation, especially for dabigatran, which implied that more physicians prefer to prescribe NOACs for NVAF patients after ablation in our country and may be attributed to the aspects such as ease of NOAC use but also possibly the greater safety and efficacy. Furthermore, the physicians may reluctant to use NOACs for high stroke risk atrial fibrillation patients after catheter ablation.

scholarly journals Estudo FATA: Prevalência de Fibrilhação Auricular e Terapêutica Antitrombótica nos Cuidados de Saúde Primários de um Concelho do Norte de Portugal

2015 ◽  
Vol 28 (1) ◽  
pp. 35 ◽  
Author(s):  
Eva Gomes ◽  
Rui Campos ◽  
Renata Morais ◽  
Marta Fernandes
Keyword(s):  
Atrial Fibrillation ◽  
Health Care ◽  
Primary Health Care ◽  
Anticoagulant Therapy ◽  
European Society ◽  
Oral Anticoagulation ◽  
Antithrombotic Therapy ◽  
Thrombotic Risk ◽  
Primary Health ◽  
European Society Of Cardiology

<strong>Introduction:</strong> Atrial fibrillation is the most prevalent sustained arrhythmia. The efficacy of oral anticoagulation has been proved in prevention stroke in these patients. However, this seems to be an underutilized treatment.<br />Objectives: to determine the prevalence of known atrial fibrillation in a Primary Health Care population; to identify major comorbidities, current antithrombotic therapy and evaluate their suitability according to the European Society of Cardiology guidelines.<br /><strong>Material and Methods:</strong> Observational cross-sectional analytical study. Population: all patients aged 30 or above, enrolled in eight Family Health Units of Vila Nova de Gaia and diagnosed with atrial fibrillation.<br /><strong>Results:</strong> Prevalence of atrial fibrillation was 1.29% (n = 940), being higher in males (p = 0.01) and increasing with age (p &lt; 0.001). The most common comorbidities were hypertension (76.4%), heart failure (32.0%) and diabetes mellitus (28.2%). A total of 52% was performing anticoagulant therapy, 29% antiplatelet agents and 4% both therapies. Of those with low thrombotic risk, 63.6% was wrongly performing some kind of antithrombotic therapy; among patients with high risk or valvular disease 56.8% was properly undergoing anticoagulant therapy.<br /><strong>Conclusion:</strong> The prevalence of atrial fibrillation as well as the frequency of the main comorbidities associated with it are in line with the majority of studies. Although most patients are undergoing oral anticoagulation, only 56.8% of those with atrial fibrillation was performing adequate antithrombotic therapy as recommended by the European Society of Cardiology guidelines, which denote a marked underutilization of this treatment.<br /><strong>Keywords:</strong> Atrial Fibrillation; Fibrinolytic Agents; Stroke; Primary Health Care; Portugal.

scholarly journals ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation31This document was approved by the American College of Cardiology Board of Trustees in August 2001, the American Heart Association Science Advisory and Coordinating Committee in August 2001, and the European Society of Cardiology Board and Committee for Practice Guidelines and Policy Conferences in August 2001.32When citing this document, the American College of Cardiology, the American Heart Association, and the European Society of Cardiology would appreciate the following citation format: Fuster V, Rydén LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, Halperin JL, Kay GN, Klein WW, Lévy S, McNamara RL, Prystowsky EN, Wann LS, Wyse DG. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2001;38:XX-XX.33This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org), the American Heart Association (www.americanheart.org), the European Society of Cardiology (www.escardio.org), and the North American Society of Pacing and Electrophysiology (www.naspe.org). Single reprints of this document (the complete Guidelines) to be published in the mid-October issue of the European Heart Journal are available by calling +44.207.424.4200 or +44.207.424.4389, faxing +44.207.424.4433, or writing Harcourt Publishers Ltd, European Heart Journal, ESC Guidelines – Reprints, 32 Jamestown Road, London, NW1 7BY, United Kingdom. Single reprints of the shorter version (Executive Summary and Summary of Recommendations) published in the October issue of the Journal of the American College of Cardiology and the October issue of Circulation, are available for $5.00 each by calling 800-253-4636 (US only) or by writing the Resource Center, American College of Cardiology, 9111 Old Georgetown Road, Bethesda, Maryland 20814. To purchase bulk reprints specify version and reprint number (Executive Summary 71-0208; full text 71-0209) up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342; or E-mail: [email protected].

2001 ◽  
Vol 38 (4) ◽  
pp. 1266 ◽  
Author(s):  
Valentin Fuster ◽  
Lars E. Rydén ◽  
Richard W. Asinger ◽  
David S. Cannom ◽  
Harry J. Crijns ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Practice Guidelines ◽  
European Society ◽  
American Heart Association ◽  
American Heart ◽  
European Heart Journal ◽  
Heart Association ◽  
Executive Summary ◽  
Esc Guidelines ◽  
European Society Of Cardiology

Anticoagulant therapy in practice

2012 ◽  
Vol 153 (19) ◽  
pp. 732-736
Author(s):  
Gergely Hofgárt ◽  
Csilla Vér ◽  
László Csiba
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Health Science ◽  
Science Centre ◽  
Improper Use ◽  
Current Guidelines

Atrial fibrillation is a risk factor for ischemic stroke. To prevent stroke oral anticoagulants can be administered. Old and new types of anticoagulants are available. Nowadays, old type, acenocumarol based anticoagulants are used preferentially in Hungary. Aim: The advantages and the disadvantages of anticoagulants are well known, but anticoagulants are underused in many cases. Method: The authors retrospectively examined how frequent atrial fibrillation was and whether the usage of anticoagulants in practice was in accordance with current guidelines among acute stroke cases admitted to the Department of Neurology, Medical and Health Science Centre of Debrecen University in 2009. Results: Of the 461 acute stroke cases, 96 patients had known and 22 patients had newly discovered atrial fibrillation. Half of the patients did not receive proper anticoagulation. Only 8.4% of them had their INR levels within the therapeutic range. Conclusions: The findings are similar to those reported in other studies. Many factors may contribute to the high proportion of improper use of anticoagulants, and further investigations are needed to determine these factors. In any case, elimination of these factors leading to a failure of anticoagulation may decrease the incidence of stroke. Orv. Hetil., 2012, 153, 732–736.

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