Anti-Coagulation with AF Flashcards
What must be done prior to commensing one of the new anticoagulants?
Assess renal function
What is the target INR for stroke reduction in AF?
2-3
What is the HAS-BLED score for? What does each letter stand for?
Risk of bleeding while on warfarin
H - Hypertension
A - abnormal liver or kidney function
S - Strokes in the past
B - Bleeding in the past
L - Labile INR
E - Elderly age
D - Drugs (NSAIDs/anti-platelets) and Alcohol
Each receives 1 point
What is the CHADS2 score cutoff for commensing anti-coagulation?
Greater than or equal to 2
What are apixaban and rivaroxaban?
Factor Xa inhibitors
How long does warfarin take to establish it’s anti-coagulatory effects?
Many days
When are the newer anti-coagulants indicated over warfarin?
If INR control is not possible to achieve - for reasons other than poor compliance
If the patient is unable to undergo INR monitoring
What is dabigatran?
A direct thrombin inhibitor
What factors act to interfere with warfarin action?
Dietary vitamin K
Hepatic enzyme profiles that vary between patients
Drug-drug interactions
Drug-disease interactions
How is dabigatran excreted? What are the implications?
Renally
Contraindicated if creatinine clearance is <30
Which node is ablated in AF?
AV
When is restoration of sinus rhythm considered in AF?
When the patient is very symptomatic and doesn’t response to rate control
