Atrial fibrillation in acute coronary syndromes: Difference between revisions
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===Current Practice Patterns Among US Interventional Cardiologists in SCAI Survey=== | ===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 ? | ||
* | *Never: 1.8% | ||
* | *Rarely: 32.9% | ||
* | *Sometimes: 35.3% | ||
* | *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 ? | ||
*ASA, clopidogrel and warfarin for one month then ASA + warfarin. 5.3% | |||
*ASA, clopidogrel and warfarin for one month then clopidogrel + warfarin. 19.3% | |||
*ASA, clopidogrel and warfarin for 6 months or more. 47.5% | |||
*ASA and clopidogrel for 6 months or more. 8.8% | |||
*Clopidogrel and warfarin for 6 months or more. 9.6% | |||
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> | | <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 | | One month triple therapy for BMS | ||
Revision as of 16:15, 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 ?
- Never: 1.8%
- Rarely: 32.9%
- Sometimes: 35.3%
- Often: 30.6%
2. What is your preferred regimen in a patient with chronic AF on warfarin and requiring a DES ?
- ASA, clopidogrel and warfarin for one month then ASA + warfarin. 5.3%
- ASA, clopidogrel and warfarin for one month then clopidogrel + warfarin. 19.3%
- ASA, clopidogrel and warfarin for 6 months or more. 47.5%
- ASA and clopidogrel for 6 months or more. 8.8%
- Clopidogrel and warfarin for 6 months or more. 9.6%
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 |}