Nonvalvular Atrial Fibrillation General Flashcards
CHA2DS2-VASc score
Congestive heart failure +1
Hypertension +1
Age≥ 75 +2
Diabetes mellitus +1
Previous stroke or TIA +2
Vascular disease (prior MI, PAD, aortic plaque) +1
Age 65–74 +1
Sex category (female) +1
CHA2DS2-VASc score Recommendations
0 in men/1 in women - Reasonable to omit antithrombotic therapy or consider aspirin
1 in men/2 in women - Consider oral anticoagulation, aspirin, or no antithrombotic therapy
2 in men/3 in women - Oral anticoagulant therapy is indicated. DOAC over warfarin in DOAC-eligible patients
Trials DOACs vs Warfarin in Stroke
Hemorrhagic stroke – All agents significantly better than warfarin.
Ischemic stroke – Only dabigatran significantly better than warfarin (unblinded)
DOACs in mothers
Avoid DOACs in pregnancy. DOACs are secreted into breast milk; therefore, an alternative mechanism of anticoagulation will be needed during breast feeding
Conditions to avoid with DOACs
patients with antiphospholipid syndrome, moderate to severe hepatic dysfunction, Bariatric surgery
NVAF and PCI Recommendations
Recommends a default strategy of an anticoagulant and a P2Y12 inhibitor
DOAC recommended over warfarin
Clopidogrel recommended over ticagrelor and prasugrel
ASA Durations after PCI in NVAF
Typically stop aspirin at hospital discharge for PCI, but may continue up to 30 days in patients
at high-risk of thrombosis and low-risk of bleeding
NVAF/PCI for stable ischemic heart disease therapy duration
anticoagulant and a P2Y12 inhibitor for 6 months (3 if high-risk of bleeding) then an anticoagulant and a P2Y12 inhibitor or aspirin for an additional 6 months, then an anticoagulant alone.
NVAF/PCI for an acute coronary syndrome therapy duration
anticoagulant and a P2Y12 inhibitor for 12 months (6 if high-risk of bleeding), then an anticoagulant alone
