ANTICOAGULATIONS FOR AF Flashcards
List the two types of anticoagulants used in AF
Parenteral and Oral Anticoagulants
What should be offered to patients with new onset AF who are receiving no anticoagulation until an assessment is made and appropriate anticoagulation is started?
Heparin(Parenteral anticoagulation
State the first-line Anticoagulant treatment for AF.
DOACS
State what is offered to patient with confirmed AF if DOACS are contraindicated eg renal impairment
Give a Vitamin K antagonist eg Warfarin
Oral anticoagulants are offered to patients with confirmed AF. True/false?
True
List the drugs used to treat SUPRAVENTRICULAR ARRHYTHMIA
Verapamil, adenosine, cardiac glycoside(digoxin)
List the drugs used to treat Ventricular Arrythmia
Sotalol, Lidocaine
What drugs are used to treat supraventricular and ventricular arrhythmia?
Amiodarone, beta blockers
state the classifications of Arrhythmias
Vaughan Williams Classification
Define Vaughan William Classification
Classification according to effects on electrical activity of heart
List the drugs in class 1 Vaughan William classification of Arrhythmia
Membrane stabilizing drugs such as Lidocaine and Flecainide plus Na channels blockers
list the drugs in class 2 VW classification
Beta blockers
List the drugs in class 111 VW
Amiodarone, Sotalol and Potassium Channel blocker
List drugs in class 4 VG classification
verapamil but not Dihydropyridines
T he preferred FIRST LINE treatment strategy for AF EXCEPT IN PATIENT WITH NEW ONSET AF IS
RATE CONTROL
State when not to use Rate control treatment in AF
New onset AF
Atrial flutter suitable for an ablation strategy
AF with reversible cause eg MI, PE, HYPERTHYROIDISM, EXCESS CAFFEINE AND ALCOHOL
Heart failure primarily caused by AF
or if Rhythm control is more suitable
What are the drugs for rate control
beta-blockers (NOT SOTALOL)
or rate-limiting CCBs such as Diltiazem(unlicensed) or Verapamil as monotherapy
or Digoxin
When should you use digoxin in AF
Digoxin monotherapy should only be considered for the initial rate control in patients with nonparoxysmal AF who are predominantly sedentary or in those where other rate-limiting drugs are unsuitable
Digoxin are also used when AF is accompanied by—-
Congestive Heart Failure
If monotherapy fails to adequately control ventricular rate, list the two drugs that can be used in combination
BB DD mnemonic
Beta blockers
digoxin
diltazem
State what to do if symptoms of AF are not still controlled with a combination of 2 drugs
Consider a rhythm control strategy
List the drugs used for rhythm control (post cardioversion)
Mnemonic: FABS(rhythmS) PD
Beta-blocker(not sotalol) as FIRST LINE
OR
Flecainide( avoid in heart disease)
Amiodarone
Propafenone(Avoid in Heart Disease)
Dronedarone
When is cardioversion used?
For patients with new-onset AF who are treated with a rhythm control strategy
Cardioversion can be pharmacological or electrical. True/False?
True
Cardioversion restores what?
Sinus rhythm
State two examples of pharmacological cardioversion
Flecainide
or
Amiodarone (if structural or ischaemic heart disease)
State what kind of cardioversion treatment is preferred if AF lasts for more than 48hours.
Electrical cardioversion is preferred over pharmacological cardioversion
What should you look out for when administering electrical cardioversion to patients with AF
Ensure that the patient is fully anticoagulated for at least three weeks because there is a risk of stroke with electrical cardioversion
State what to do if electrical cardioversion cannot be delayed until the patient is fully anticoagulated
Give heparin immediately before cardioversion
Oral anticoagulation should be given after CARDIOVERSION and continued for at least 4 weeks. True/false?
True
Name the tool used to assess the risk of stroke in AF patients prior to and during anticoagulation
CHA2DS2-VASC tool
ATRIA Stroke risk tool and QStroke calculator
State the tools used to assess bleeding risk in AF patient
ORBIT (Higher accuracy than other tools eg HAS BLED, ATRIA)
State the following meaning of CHA2DSC-VASC SCORE
C- Congestive heart failure adds 1 point
H- Hypertension adds 1 point
A- Age greater than or equal to 75yrs adds
2 point
- Diabetes mellitus or T2D adds 1point
S- Prior Stroke or TIA adds to 2point
V- Vascular disease adds to 1 point
A- Age between 65 and 74years adds 1point
S- Female sex adds 1 point
Anticoagulant for a man starts from what number ?
1
When to give anticoagulants?
Give Anticoagulant when CHASDVAS2C score is greater than or =2
memory trick to give anticoagulants
ANtwocoagulants
