Atrial fibrillation in acute coronary syndromes: Difference between revisions
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*It is not unreasonable to use [[dabigatran]] in place of [[warfarin]] | *It is not unreasonable to use [[dabigatran]] in place of [[warfarin]] | ||
===Current Practice Patterns Among US Interventional Cardiologists in SCAI Survey=== | |||
1.How often do you use a drug eluting stent in patients with AF on warfarin ? | 1.How often do you use a drug eluting stent in patients with AF on warfarin ? | ||
*a.Never 1.8% | *a.Never: 1.8% | ||
b.Rarely 32.9% | *b.Rarely: 32.9% | ||
c.Sometimes 35.3% | *c.Sometimes: 35.3% | ||
d.Often 30.6% | *d.Often: 30.6% | ||
2. What is your preferred regimen in a patient with chronic AF on warfarin and requiring a DES ? | 2. What is your preferred regimen in a patient with chronic AF on warfarin and requiring a DES ? | ||
Revision as of 16:13, 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
Current Practice Patterns Among US Interventional Cardiologists in SCAI Survey
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%
2. What is your preferred regimen in a patient with chronic AF on warfarin and requiring a DES ?
|
| 6 months triple therapy for DES |- | 3. What is your preferred regimen in a patient with chronic AF on warfarin and requiring a BMS ?
|
| One month triple therapy for BMS |}