Atrial fibrillation in acute coronary syndromes: Difference between revisions
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==Treatment== | ==Treatment== | ||
===General Guidelines in North America=== | ===General Guidelines in North America=== | ||
*Low dose aspirin (<100 mg per day) | |||
*Clopidogrel is preferred in combination with aspirin and warfarin. | |||
*Prasugrel and ticagrelor cannot be recommended | |||
*Warfarin dose adjusted INR between 2 and 2.5. | |||
*Not unreasonable to use dabigatran in place of warfarin based on the PETRO trial (dabigatran 50, 150, 300 mg BID with or without aspirin vs warfarin) | |||
==References== | ==References== | ||
Revision as of 16:04, 2 September 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Atrial fibrillation occurs in 1 to 20% of patients with acute coronary syndromes and is associated with a poorer prognosis.
Epidemiology and Demographics
Atrial fibrillation occurs in 1 to 20% (about 10%) of patients with acute coronary syndromes [1]
Risk Factors
Risk factors for the development of atrial fibrillation in the setting of ACS include:
- Female gender
- Older age
- Left ventricular dysfunction
Natural History, Complications, Prognosis
The occurrence of atrial fbrillation in the setting of acute coronary syndromes is associated with a poorer prognosis [2]:
- Any AF is associated with higher in hospital (OR 2.7), 30-day (OR 2.2), and 1-year mortality (OR 2.1) (p<0.001)
- New-onset AF was associated with higher in hospital (OR 5.2), 30-day (OR 3.9), and 1-year mortality (OR 3.1) (p<0.001)
Treatment
General Guidelines in North America
- Low dose aspirin (<100 mg per day)
- Clopidogrel is preferred in combination with aspirin and warfarin.
- Prasugrel and ticagrelor cannot be recommended
- Warfarin dose adjusted INR between 2 and 2.5.
- Not unreasonable to use dabigatran in place of warfarin based on the PETRO trial (dabigatran 50, 150, 300 mg BID with or without aspirin vs warfarin)