Atrial fibrillation in acute coronary syndromes: Difference between revisions
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===Current Practice Patterns Regarding the Patient with ACS and Atrial Fibrillation Among US Interventional Cardiologists in SCAI Survey=== | ===Current Practice Patterns Regarding the Patient with ACS and Atrial Fibrillation Among US Interventional Cardiologists in SCAI Survey=== | ||
In general, most interventional cardiologists place a drug eluting stent and treat with "triple therapy" of ASA, clopidogrel and warfarin for 6 months after the procedure <ref> | |||
Faxon D, Thrombosis & Hemostasis 2011;106(3):522-34 | |||
: | |||
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% | *Never: 1.8% | ||
Revision as of 17:09, 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 Regarding the Patient with ACS and Atrial Fibrillation Among US Interventional Cardiologists in SCAI Survey
In general, most interventional cardiologists place a drug eluting stent and treat with "triple therapy" of ASA, clopidogrel and warfarin for 6 months after the procedure <ref>
Faxon D, Thrombosis & Hemostasis 2011;106(3):522-34
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?
- ASA, clopidogrel and warfarin for one month then ASA + warfarin: 86.5%
- ASA, clopidogrel and warfarin for one month then clopidogrel + warfarin: 7.6%
- ASA, clopidogrel and warfarin for 6 months or more: 3.2%
- ASA and clopidogrel for 6 months or more: 1.3%
- Clopidogrel and warfarin for 6 months or more: 0.6%