Anticoagulation and AF

Question 1

Stroke prevention in AF

Answer 1

RRR

Aspirin 22%
Warfarin 38%
DAOC 19% - reduction in haemorrhagic stroke (59%)

Question 2

GARFIELD AF Registry for warfarin

Answer 2

30% patients in Asia were in therapeutic range 2-3
4-times higher risk of ICH compared to western population

Question 3

Benefits of DOAC

Answer 3

Rapid onset
Fixed dosing
Very few interactions
No need monitoring
Short half life
Emerging antidote

Question 4

DOAC choice in elderly

Answer 4

Apixaban 5mg BD
2nd choice - dabi, rivaroxaban

Apixaban has slightly more favourable bleeding profile

Question 5

Apixaban in renal failure

Answer 5

Previously apixaban only DOAC used up to CK5 (eGFR 15mL/min), other DOACs unsafe for CKD 4

Latest guideline allow use in haemodialysis
AXADIA-AFNET 8 (2022) and Renal-AF (2022)

Question 6

Management of AF detected after stroke

Answer 6

1 for male or 2 for female - class 2 - use DOAC, warfarin not beneficial
2 for male, 3 for female - class 1 - DOAC > warfarin

Question 7

Reversal

Answer 7

Question 8

Bridging VKA to DOAC

Answer 8

Question 9

DOAC Drug Interactions

Answer 9