Atrial Fibrillation

Question 1

drug agents used in valvular arrhythmia?

Answer 1

warfarin & UFH

Question 2

drug agents used in non-valvular arrhythmia?

Answer 2

anything; warfarin, DOAC, unfractionated heparin

Question 3

Modifiable factors under HAS-BLED scale?

Answer 3

1.Hypertension/elevated SBP
2.INR control (target 2.0-3.0)ª;
target TTR ≥65%
3.Concomitant APTs and NSAIDs
4.Excessive alcohol intake
5.Nonadherence to OAC/APT
6.Avoidance of hazardous hobbies/occupations
7.Avoidance of bridging therapy with OAC
6.Appropriate choice of OAC and correct dose®

Question 4

Non-modifiable bleeding risk factors under HAS-BLED?

Answer 4

1.Age (>65 y)
2.Previous major bleeding
3.Severe renal impairment (dialysis or renal transplant)
4.Severe hepatic disease (cirrhosis)
5.Malignancy
6.Genetic factors (eg, CYP 2C9 polymorphisms)
7.Previous stroke, small vessel disease etc
8.Diabetes mellitus
9.Cognitive impairment/dementia

Question 5

conditions where DOAC are not indicated?

Answer 5

1.Valvular Disease
-Bioprosthetic, mechanical
-Location (tricuspid, pulmonic, mitral, aortic)
2.Ischemic Heart Disease
-Acute Coronary Syndrome (ACS)
-Procedural - PCI, CABG
3.Others
* Antiphospholipid syndrome, Heparin-Induced
Thrombocytopenia (HIT)

Question 6

when is the apixaban-2.5mg BID given to patients?

Answer 6

2.5mg BID in patients ≥2 of: SrCr ≥133 umol/L, age ≥80 yr, wt ≤60kg

Question 7

what’s considered a “high-risk patient” patient in the context of post-myocardial infraction?

Answer 7

Diabetes mellitus, prior ACS, chronic renal dysfunction (ClCr <60 mL/min), prior stent thrombosis, current smoker, multivessel disease, multiple stents implanted, complex bifurcation lesion, total stent length >60 mm, chronic total occlusion intervention or bioabsorbable vascular scaffold (BVS) implantation.

Question 8

what determines that one is at a high risk of bleeding?

Answer 8

non-modifiable risks:
Age (>65 y)
Previous major bleeding
Severe renal impairment (dialysis or renal transplant)
Severe hepatic disease (cirrhosis)
Malignancy
Genetic factors (eg, CYP 2C9 polymorphisms)
Previous stroke, small vessel disease etc
Diabetes mellitus
Cognitive impairment/dementia
modifiable risks:

Modifiable risks:
Hypertension/elevated SBP
INR control (target 2.0-3.0)
target TTR ≥65%
Concomitant APTs and NSAIDs
Excessive alcohol intake
Nonadherence to OAC/APT
Avoidance of hazardous hobbies/occupations
Avoidance of bridging therapy with OAC
Appropriate choice of OAC and correct dose

potentially modifiable risk factors:
Extreme frailty # excessive falls riske
VKA management strategy*
Anemia
Reduced platelet count or function
Renal impairment (CrCl >30 mL/min)

Question 9

what is defined as vascular disease?

Answer 9

rheumatic mitral stenosis, moderate/severe non-rheumatic mitral stenosis, mechanical valve

(*DO NOT USE DOAC)

Question 10

At what age do patients who experience atrial fibrillation start DOAC immediately?

Answer 10

greater than or equal to 65

Question 11

when is triple therapy recommended in atrial fibrillation?

Answer 11

ACS + ELECTIVE PCI OR PCI + ASA
(*Aspirin is stopped after 30 days & Dual therapy is continued for upto 1 year).