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Book Details
Abstract
Get a quick, expert overview of stroke risks among patients with treated and untreated atrial fibrillation, in addition to best practices for management and treatment of patients with atrial fibrillation to minimize stroke risks. This concise, clinically-focused resource by Dr. Greg Flaker consolidates today’s available information on this timely topic into one convenient resource, making it an ideal, easy-to-digest reference for practicing and trainee cardiologists as well as general practitioners treating and monitoring these patients.
- Covers a broad spectrum of management and treatment options for atrial fibrillation including anticoagulants, surgical and implanted devices.
- Presents information on recent drug trials to keep you up to date with the latest developments.
- Includes guidance on anticoagulation in special situations, such as cardioversion and ablation, in addition to atrial fibrillation treatment in patients with other medical conditions including cancer, major bleeding disorders, and renal or liver disease.
- Chapter on Risk Stratification assists in identifying patients with a high risk of stroke and predicting treatment outcomes.
- Chapter on The New Anticoagulation Clinic overviews best practices for patient education, compliance, follow-up monitoring, and quality assurance to aid in better patient outcomes.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Stroke Prevention in Atrial Fibrillation | i | ||
| Stroke Prevention in Atrial Fibrillation | iii | ||
| Copyright | iv | ||
| List of Contributors | v | ||
| Foreword | vii | ||
| Contents | ix | ||
| 1 - An Economic Analysis of Stroke and Atrial Fibrillation | 1 | ||
| INTRODUCTION | 1 | ||
| DIRECT COST OF STROKE | 2 | ||
| INDIRECT COST OF STROKE | 3 | ||
| INTANGIBLE COSTS | 3 | ||
| IMPACT OF ATRIAL FIBRILLATION ON STROKE-RELATED COSTS | 4 | ||
| COST-EFFECTIVENESS OF TREATMENTS FOR STROKE PREVENTION IN ATRIAL FIBRILLATION | 4 | ||
| ECONOMIC ANALYSIS OF ANTICOAGULATION FOR STROKE PREVENTION | 5 | ||
| LIMITATIONS OF COST ANALYSIS STUDIES | 5 | ||
| COST-EFFECTIVENESS OF THE NEW ANTICOAGULANTS | 6 | ||
| CONCLUSION | 7 | ||
| REFERENCES | 7 | ||
| 2 - Pharmacology of Oral Anticoagulants | 11 | ||
| VITAMIN K ANTAGONISTS | 11 | ||
| Pharmacology | 11 | ||
| Pharmacokinetics and pharmacodynamics | 11 | ||
| Drug interactions | 14 | ||
| DIRECT THROMBIN INHIBITORS | 20 | ||
| Pharmacokinetics | 21 | ||
| Drug interactions | 22 | ||
| DIRECT FACTOR XA INHIBITORS | 23 | ||
| General Pharmacology | 23 | ||
| Pharmacokinetics | 25 | ||
| Dosing | 25 | ||
| Drug interactions | 26 | ||
| Pharmacokinetics | 27 | ||
| Dosing | 27 | ||
| Drug interactions | 27 | ||
| Pharmacokinetics | 28 | ||
| Dosing | 28 | ||
| Drug interactions | 29 | ||
| DISCLOSURE STATEMENT | 29 | ||
| REFERENCES | 29 | ||
| 3 - Anticoagulation Drug Trials for Stroke Prevention in Atrial Fibrillation | 35 | ||
| INTRODUCTION | 35 | ||
| ASPIRIN AND OTHER ANTIPLATELET AGENTS | 35 | ||
| VITAMIN K ANTAGONISTS | 37 | ||
| NON–VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS TRIALS | 38 | ||
| RHEUMATIC ATRIAL FIBRILLATION | 44 | ||
| UNANSWERED QUESTIONS AND FUTURE TRIALS | 44 | ||
| REFERENCES | 44 | ||
| 4 - Risk Stratification in Atrial Fibrillation | 47 | ||
| INTRODUCTION | 47 | ||
| CHADS2 | 47 | ||
| CHA2DS2VASC | 48 | ||
| R2CHADS2 SCORE | 48 | ||
| QSTROKE SCORE | 49 | ||
| ATRIA STROKE SCORE | 49 | ||
| DO BIOMARKERS IMPROVE RISK ASSESSMENT FOR ATRIAL FIBRILLATION–RELATED STROKE? | 49 | ||
| THE ABC-STROKE SCORE | 50 | ||
| ASSESSMENT OF BLEEDING RISK IN PATIENTS WITH ATRIAL FIBRILLATION | 51 | ||
| HAS-BLED | 52 | ||
| HEMORR2HAGES | 53 | ||
| ORBIT | 53 | ||
| ABC BLEEDING SCORE | 54 | ||
| CENTRAL NERVOUS SYSTEM IMAGING TO REFINE STROKE AND BLEEDING RISK ASSESSMENT | 54 | ||
| DOES EVERYONE WITH ATRIAL FIBRILLATION NEED STROKE RISK ASSESSMENT? | 56 | ||
| THE ELDERLY | 56 | ||
| PAROXYSMAL ATRIAL FIBRILLATION AND STROKE RISK | 57 | ||
| FUTURE DIRECTIONS TO IMPROVE RISK SCORES | 60 | ||
| Ethnicity | 60 | ||
| CONCLUSION | 61 | ||
| REFERENCES | 61 | ||
| 5 - Subclinical Atrial Fibrillation: Definition, Prevalence, and Treatment Strategies | 67 | ||
| INTRODUCTION | 67 | ||
| DEFINING SUBCLINICAL ATRIAL FIBRILLATION | 67 | ||
| PREVALENCE OF SUBCLINICAL ATRIAL FIBRILLATION | 68 | ||
| SUBCLINICAL ATRIAL FIBRILLATION AND STROKE RISK | 69 | ||
| THE PATHOGENESIS OF SUBCLINICAL ATRIAL FIBRILLATION STROKE RISK | 73 | ||
| STROKE RISK STRATIFICATION IN PATIENTS WITH SUBCLINICAL ATRIAL FIBRILLATION | 75 | ||
| TREATMENT OF SUBCLINICAL ATRIAL FIBRILLATION | 75 | ||
| CONCLUSIONS | 76 | ||
| REFERENCES | 76 | ||
| 6 - The New Anticoagulation Clinic | 79 | ||
| INTRODUCTION | 79 | ||
| FUNCTION OF ANTICOAGULATION CLINICS | 79 | ||
| ROLE OF THE ANTICOAGULATION CLINICIAN | 81 | ||
| QUALITY OF CARE | 81 | ||
| EVOLVING ROLE OF THE ANTICOAGULATION CLINIC | 82 | ||
| EXPANDING THE ROLE OF THE ANTICOAGULATION CLINIC | 84 | ||
| PERIPROCEDURAL PLANNING | 84 | ||
| TOTAL WELLNESS OPTIONS | 85 | ||
| COMPLEX MEDICATION MANAGEMENT | 86 | ||
| POPULATION HEALTH | 87 | ||
| DISEASE STATE CLINICS: PULMONARY EMBOLISM MANAGEMENT | 87 | ||
| CONCLUSION | 88 | ||
| REFERENCES | 88 | ||
| 7 - Management of Bleeding Associated With Anticoagulation | 91 | ||
| BACKGROUND | 91 | ||
| INCIDENCE MAJOR BLEEDING | 91 | ||
| Apixaban | 91 | ||
| Rivaroxaban | 91 | ||
| Edoxaban | 93 | ||
| Dabigatran | 93 | ||
| PATHWAY FOR MANAGING THE BLEEDING PATIENT | 94 | ||
| Step 1: Bleeding Definitions and Initial Assessment | 94 | ||
| Step 2: Fluid Resuscitation | 94 | ||
| Step 3: Laboratory Testing | 95 | ||
| Step 4: Managing Vitamin K Antagonist or Direct Oral Anticoagulant Major Bleeding (Table 7.3) | 95 | ||
| Vitamin K antagonist (warfarin) | 95 | ||
| Factor Xa inhibitors (rivaroxaban, apixaban, edoxaban) | 97 | ||
| Andexanet alfa (andexanet): reversal agent factor Xa inhibitors | 97 | ||
| Management factor IIa inhibitors (dabigatran) | 97 | ||
| Idarucizumab (praxabind): reversal agent factor IIa inhibitor | 98 | ||
| Step 5: Restarting Anticoagulation Following Major Bleeding | 98 | ||
| Gastrointestinal bleeding | 98 | ||
| Intracranial hemorrhage | 99 | ||
| Restarting anticoagulation after a surgery/procedure. If anticoagulation was discontinued and rescued or reversed for an urgent ... | 99 | ||
| CONCLUSION (FIG. 7.1) | 100 | ||
| REFERENCES | 100 | ||
| 8 - Periprocedural Management of Anticoagulation in Patients With Atrial Fibrillation | 105 | ||
| BACKGROUND | 105 | ||
| GENERAL PRINCIPLES FOR PERIPROCEDURAL MANAGEMENT OF ANTICOAGULATION | 105 | ||
| IDENTIFICATION OF THE PATIENT AT HIGH RISK FOR A THROMBOEMBOLIC EVENT DURING ANTICOAGULATION INTERRUPTION | 105 | ||
| IDENTIFICATION OF THE PATIENT AT LOW RISK FOR THROMBOEMBOLIC EVENT DURING ANTICOAGULATION INTERRUPTION | 106 | ||
| Periprocedural Bleeding Risk | 108 | ||
| IDENTIFICATION OF SURGICAL PROCEDURES AT LOW RISK FOR BLEEDING | 111 | ||
| ANTICOAGULATION INTERRUPTION BEFORE SURGERY | 111 | ||
| Vitamin K Antagonists | 111 | ||
| Direct Oral Anticoagulants | 112 | ||
| Need for parenteral bridging anticoagulation | 113 | ||
| Direct Oral Anticoagulants | 113 | ||
| Warfarin | 115 | ||
| Bridging anticoagulation recommendations | 115 | ||
| Reinitiation of bridging anticoagulation postprocedure | 115 | ||
| Reinitiation of Direct Oral Anticoagulant postprocedure | 116 | ||
| Reinitiation of warfarin postprocedure | 116 | ||
| SUMMARY | 117 | ||
| REFERENCES | 118 | ||
| 9 - Special Situations: Anticoagulation for Cardioversion | 121 | ||
| ANTICOAGULATION BEFORE CARDIOVERSION | 121 | ||
| The Role of Transesophageal Echocardiogram | 122 | ||
| Direct Oral Anticoagulation | 123 | ||
| ANTICOAGULATION AFTER CARDIOVERSION | 124 | ||
| SUMMARY | 125 | ||
| REFERENCES | 125 | ||
| 10 - Anticoagulation for Ablation Procedures | 129 | ||
| REFERENCES | 131 | ||
| 11 - Surgical and Implanted Devices for the Left Atrial Appendage | 133 | ||
| PHYSIOLOGY OF COAGULATION IN ATRIAL FIBRILLATION | 133 | ||
| IMPORTANCE OF LEFT ATRIAL APPENDAGE IN ATRIAL FIBRILLATION–ASSOCIATED THROMBOEMBOLISM | 133 | ||
| SURGICAL TECHNIQUES FOR LEFT ATRIAL APPENDAGE EXCLUSION | 135 | ||
| LARIAT DEVICE | 137 | ||
| LEFT ATRIAL APPENDAGE OCCLUSION DEVICES | 138 | ||
| WATCHMAN DEVICE | 138 | ||
| PATIENT SELECTION AND APPROVAL | 140 | ||
| AMPLATZER DEVICE | 140 | ||
| WAVECREST DEVICE | 143 | ||
| PERIPROCEDURAL AND LONG-TERM ANTICOAGULATION | 143 | ||
| COSTEFFECTIVENESS OF LEFT ATRIAL APPENDAGE OCCLUDER DEVICES | 144 | ||
| CONCLUSION | 144 | ||
| REFERENCES | 145 | ||
| 12 - Patients Taking Oral Anticoagulants for Atrial Fibrillation With Concomitant Complex Disease States | 149 | ||
| MANAGEMENT OF ANTICOAGULANTS IN ASSOCIATION WITH ANTIPLATELET THERAPY | 149 | ||
| Case | 149 | ||
| PATIENTS WITH A PRIOR CEREBROVASCULAR ACCIDENT OR INTRACRANIAL HEMORRHAGE | 152 | ||
| Case: Ischemic Stroke | 152 | ||
| Stroke While on Anticoagulation | 152 | ||
| Cryptogenic Stroke | 153 | ||
| Case: Intracranial Hemorrhage | 153 | ||
| PATIENTS WITH ATRIAL FIBRILLATION AND UNDERLYING CANCER DIAGNOSIS: IMPLICATIONS FOR ANTITHROMBOTIC THERAPY | 154 | ||
| Case | 154 | ||
| SPECIAL PATIENT POPULATIONS AND PATIENTS WHO ARE EXCLUDED FROM CLINICAL TRIALS THAT PRESENT CHALLENGES IN ANTICOAGULATION FOR AT... | 155 | ||
| Case | 155 | ||
| Renal Function | 156 | ||
| Hepatic Dysfunction | 156 | ||
| Variations in Body Weight | 156 | ||
| Drug Interactions | 157 | ||
| REFERENCES | 158 | ||
| 13 - Stroke and Atrial Fibrillation: The Neurologist’s Perspective | 161 | ||
| INTRODUCTION | 161 | ||
| EPIDEMIOLOGY | 161 | ||
| PATHOPHYSIOLOGY | 162 | ||
| CLINICAL PRESENTATION | 162 | ||
| DIAGNOSIS | 162 | ||
| ACUTE TREATMENT OF ATRIAL FIBRILLATION–ASSOCIATED STROKE | 166 | ||
| STROKE OUTCOMES IN ATRIAL FIBRILLATION | 167 | ||
| SECONDARY STROKE PREVENTION IN ATRIAL FIBRILLATION: ANTICOAGULATION FOR ALL? YES! | 167 | ||
| ATRIAL FIBRILLATION AND STROKE: MAJOR PROGRESS IN STROKE PREVENTION | 168 | ||
| REFERENCES | 168 | ||
| 14 - Stroke and Atrial Fibrillation in Chronic Kidney Disease and Dialysis | 171 | ||
| Introduction | 171 | ||
| Ischemic Stroke in Chronic Kidney Disease and Dialysis | 171 | ||
| Epidemiology | 171 | ||
| Etiology | 172 | ||
| Outcomes After Stroke | 173 | ||
| Atrial Fibrillation in Chronic Kidney Disease and Dialysis | 173 | ||
| Epidemiology | 173 | ||
| Risk of Stroke Associated With Atrial Fibrillation | 174 | ||
| Risk of Bleeding in Chronic Kidney Disease | 175 | ||
| Therapies to Prevent Strokes in Patients With Chronic Kidney Disease and Atrial Fibrillation | 175 | ||
| Studies suggesting harm | 177 | ||
| Lack of consensus on use of anticoagulation for stroke prevention.Uncertainty of the benefits and risks of therapies to reduce t... | 178 | ||
| Direct Oral Anticoagulants in Chronic Kidney Disease or Dialysis | 179 | ||
| Left Atrial Occlusion Devices | 179 | ||
| Patients’ Values and Preferences | 179 | ||
| Future Directions | 179 | ||
| Conclusions | 180 | ||
| REFERENCES | 180 | ||
| Index | 185 | ||
| A | 185 | ||
| B | 186 | ||
| C | 186 | ||
| D | 187 | ||
| E | 187 | ||
| F | 188 | ||
| G | 188 | ||
| H | 188 | ||
| I | 188 | ||
| J | 189 | ||
| K | 189 | ||
| L | 189 | ||
| M | 189 | ||
| N | 189 | ||
| O | 189 | ||
| P | 190 | ||
| Q | 190 | ||
| R | 190 | ||
| S | 190 | ||
| T | 191 | ||
| V | 191 | ||
| W | 192 | ||
| X | 192 |