Atrial fibrillation secondary prevention: Difference between revisions

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(/* ACCF/AHA/HRS 2011 Guidelines - Atrial Fibrillation - Secondary Prevention with Thromboembolism Prevention (DO NOT EDIT) {{cite journal| author=Wann LS, Curtis AB, Ellenbogen KA, Estes NA, Ezekowitz MD, Jackman WM et al.| title=2011 ACCF/AHA/HRS...)
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==Overview==
==Overview==
==ACCF/AHA/HRS 2011 Guidelines - Atrial Fibrillation - Secondary Prevention with Thromboembolism Prevention (DO NOT EDIT) <ref name="pmid21321155">{{cite journal| author=Wann LS, Curtis AB, Ellenbogen KA, Estes NA, Ezekowitz MD, Jackman WM et al.| title=2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (update on Dabigatran): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. | journal=Circulation | year= 2011 | volume= 123 | issue= 10 | pages= 1144-50 | pmid=21321155 | doi=10.1161/CIR.0b013e31820f14c0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21321155  }} </ref>==
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''Antithrombotic therapy to prevent [[thromboembolism]] is recommended for all patients with [[AF]], except those with lone AF or contraindications. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]) <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' The antithrombotic agent should be chosen based upon the absolute risks of [[stroke]] and bleeding and the relative risk and benefit for a given patient. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]) <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' For patients at high risk of stroke, chronic oral anticoagulant therapy with a vitamin K antagonist (INR 2.0 to 3.0) is recommended, unless contra-indicated. Factors associated with highest risk for stroke in patients with AF are prior stroke, TIA, or [[systemic embolism]], [[rheumatic mitral stenosis]] and a [[mechanical heart valve]]. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]) <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.'''Anticoagulation with a vitamin K antagonist is recommended for patients with more than 1 moderate risk factor (age >75 years, [[hypertension]], [[diabetes mellitus]], [[HF]], or impaired [[LV]] systolic function [ejection fraction ≥ 35% or fractional shortening < 25%]).  ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]) <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.'''INR should be determined at least weekly during initiation of therapy and monthly when stable.  ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]) <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''6.''' [[Aspirin]], 81–325 mg daily, is recommended in low-risk patients or in those with contraindications to oral anticoagulation. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]) <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''7.''' For patients with [[AF]] who have mechanical heart valves, the target intensity of anticoagulation should be based on the type of prosthesis, maintaining an INR of at least 2.5. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''8.''' Antithrombotic therapy is recommended for patients with [[atrial flutter]] as for AF. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''9.''' [[Dabigatran]] is useful as an alternative to [[warfarin]] for the prevention of stroke and [[systemic thromboembolism]] in patients with paroxysmal to permanent [[AF]] and risk factors for [[stroke]] or systemic [[embolization]] who do not have a [[prosthetic heart valve]] or hemodynamically significant valve disease, severe [[renal failure]] (creatinine clearance <15 mL/ min) or advanced liver disease (impaired baseline clotting function). ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) <nowiki>"</nowiki>
|}
{|class="wikitable"
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Long-term anticoagulation is not recommended for primary stroke prevention in patients below age 60 years without heart disease (lone AF).([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' For primary prevention of [[thromboembolism]] in patients with [[nonvalvular AF]] who have just 1 of the validated risk factors (age >75 years (especially in female patients), [[hypertension]], [[diabetes mellitus]], [[HF]], or impaired [[LV]] function), antithrombotic therapy with either aspirin or a vitamin K antagonist is reasonable, based upon an assessment of the risk of bleeding complications, ability to safely sustain anticoagulation, and patient preferences. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]]) <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' For patients with nonvalvular AF who have 1 or more of the less well-validated risk factors (age 65-74 years, female gender, or [[CAD]]), treatment with either aspirin or a vitamin K antagonist is reasonable. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' It is reasonable to select antithrombotic therapy using the same criteria irrespective of the pattern (paroxysmal, persistent, or permanent) of AF. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' In patients with AF without a mechanical heart valve, it is reasonable to interrupt anticoagulation for up to 1 wk for procedures that carry a risk of bleeding. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' It is reasonable to re-evaluate the need for anticoagulation at regular intervals. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
|}
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' In patients 75 years of age and older at risk of bleeding but without contraindications to anticoagulant therapy, and in patients who are unable to safely tolerate standard anticoagulation (INR 2.0 to 3.0), a lower INR target (2.0;
range 1.6 to 2.5) may be considered for primary prevention of stroke and systemic embolism. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' When interruption of oral anticoagulant therapy for longer than 1 wk is necessary in high-risk patients, unfractionated or low-molecular-weight heparin may be given by injection, although efficacy is uncertain. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Following [[coronary revascularization]] in patients with AF, low-dose [[aspirin]] (<100 mg daily) and/or [[clopidogrel]] (75 mg daily) may be given concurrently with anticoagulation, but these strategies are associated with an increased risk of bleeding. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' In patients undergoing [[coronary revascularization]], anticoagulation may be interrupted to prevent bleeding, but should be resumed as soon as possible after the procedure and the dose adjusted to achieve a therapeutic [[INR]]. Aspirin may be given during the hiatus. For patients undergoing [[percutaneous intervention]], the maintenance regimen should consist of [[clopidogrel]], 75 mg daily, plus [[warfarin]] (INR 2.0 to 3.0). [[Clopidogrel]] should be given for a minimum of 1 mo after a bare metal stent, at least 3 mo for a sirolimus-eluting stent, at least 6 mo for a paclitaxeleluting [[stent]], and 12 mo or longer in selected patients, followed by warfarin alone. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''5.''' In patients with AF who sustain [[ischemic stroke]] or [[systemic embolism]] during treatment with anticoagulation (INR 2.0 to 3.0), it may be reasonable to raise the intensity of anticoagulation up to a target INR of 3.0 to 3.5. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''6.''' The addition of [[clopidogrel]] to [[aspirin]] to reduce the risk of major vascular events, including stroke, might be considered in patients with AF in whom oral anticoagulation with [[warfarin]] is considered unsuitable due to patient preference or the physician’s assessment of the patient’s ability to safely sustain anticoagulation. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]]) <nowiki>"</nowiki>
|}


==ACCF/AHA/HRS 2011 Guidelines - Atrial Fibrillation - Secondary Prevention with Pacing (DO NOT EDIT) <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref><ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>==
==ACCF/AHA/HRS 2011 Guidelines - Atrial Fibrillation - Secondary Prevention with Pacing (DO NOT EDIT) <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref><ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>==

Revision as of 16:27, 12 October 2012

Conduction
Sinus rhythm
Atrial fibrillation
'
ICD-10 I48
ICD-9 427.31
DiseasesDB 1065
MedlinePlus 000184

Atrial Fibrillation Microchapters

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Postoperative AF
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Synonyms and related keywords: AF, Afib, fib

Overview

ACCF/AHA/HRS 2011 Guidelines - Atrial Fibrillation - Secondary Prevention with Pacing (DO NOT EDIT) [1][2]

Class III
"1. Permanent pacing is not indicated for the prevention of AF in patients without any other indication for pacemaker implantation. (Level of Evidence: B)"

Vote on and Suggest Revisions to the Current Guidelines

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References

  1. ↑ 1.0 1.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
  2. ↑ 2.0 2.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
  3. ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199

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