Atrial fibrillation in acute coronary syndromes: Difference between revisions
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*Warfarin dose adjusted [[International Normalized Ratio]] ([[INR]]) between 2 and 2.5 | *Warfarin dose adjusted [[International Normalized Ratio]] ([[INR]]) between 2 and 2.5 | ||
*It is not unreasonable to use [[dabigatran]] in place of [[warfarin]] | *It is not unreasonable to use [[dabigatran]] in place of [[warfarin]] | ||
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| 1.How often do you use a drug eluting stent in patients with AF on warfarin ? | |||
| <div>a.Never 1.8 %</div> <div>b.Rarely 32.9 %</div> <div>c.Sometimes 35.3%</div> <div>d.Often 30.6%</div> | |||
| DES most often placed | |||
|- | |||
| 2. What is your preferred regimen in a patient with chronic AF on warfarin and requiring a DES ? | |||
| <div>a.ASA, clopidogrel and warfarin for one month then ASA + warfarin. 5.3%</div> <div>b. ASA, clopidogrel and warfarin for one month then clopidogrel + warfarin. 19.3%</div> <div>c. ASA, clopidogrel and warfarin for 6 months or more. 47.5%</div> <div>d.ASA and clopidogrel for 6 months or more. 8.8%</div> <div>e.Clopidogrel and warfarin for 6 months or more. 9.6%</div> | |||
| 6 months triple therapy for DES | |||
|- | |||
| 3. What is your preferred regimen in a patient with chronic AF on warfarin and requiring a BMS ? | |||
| <div>a.ASA, clopidogrel and warfarin for one month then ASA + warfarin. 86.5%</div> <div>b. ASA, clopidogrel and warfarin for one month then clopidogrel + warfarin. 7.6%</div> <div>c. ASA, clopidogrel and warfarin for 6 months or more. 3.2%</div> <div>d.ASA and clopidogrel for 6 months or more. 1.3%</div> <div>e.Clopidogrel and warfarin for 6 months or more. 0.6%</div> | |||
| One month triple therapy for BMS | |||
|} | |||
==References== | ==References== | ||
Revision as of 16:10, 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 International Normalized Ratio (INR) between 2 and 2.5
- It is not unreasonable to use dabigatran in place of warfarin
| 1.How often do you use a drug eluting stent in patients with AF on warfarin ? | a.Never 1.8 % b.Rarely 32.9 % c.Sometimes 35.3% d.Often 30.6%
|
DES most often placed |
| 2. What is your preferred regimen in a patient with chronic AF on warfarin and requiring a DES ? | a.ASA, clopidogrel and warfarin for one month then ASA + warfarin. 5.3% b. ASA, clopidogrel and warfarin for one month then clopidogrel + warfarin. 19.3% c. ASA, clopidogrel and warfarin for 6 months or more. 47.5% d.ASA and clopidogrel for 6 months or more. 8.8% e.Clopidogrel and warfarin for 6 months or more. 9.6%
|
6 months triple therapy for DES |
| 3. What is your preferred regimen in a patient with chronic AF on warfarin and requiring a BMS ? | a.ASA, clopidogrel and warfarin for one month then ASA + warfarin. 86.5% b. ASA, clopidogrel and warfarin for one month then clopidogrel + warfarin. 7.6% c. ASA, clopidogrel and warfarin for 6 months or more. 3.2% d.ASA and clopidogrel for 6 months or more. 1.3% e.Clopidogrel and warfarin for 6 months or more. 0.6%
|
One month triple therapy for BMS |