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Antithrombotic policies in atrial fibrillation patients

  • Atrial fibrillation and stroke: does the atrial fibrillation burden matter? Presented by G L Botto (S.Fermo Db - Como, IT) - Slides
  • Risk stratification: the balance between stroke and bleeding, presented by G Y H Lip (Birmingham, GB)
  • New preventive strategies: drugs and devices, presented by P Neuzil (Praha, CZ) - Slides
  • Anticoagulation after ablation: what is optimal? Presented by H Mavrakis (Heraklion, GR) - Slides
Atrial Fibrillation


Atrial fibrillation and stroke: does the atrial fibrillation burden matter?

Dr. Botto started the session by presenting data on the burden of AF and the risk of stroke. He emphasized the importance of the detection of silent AF as the risk of stroke is similar among patients with asymptomatic and symptomatic AF. The problematic patient groups are those with short episodes of AF. These can be detected only by using implantable devices which monitor the heart rhythm continuously.

Risk stratification: the balance between stroke and bleeding

According to Prof. Lip, the recently developed CHA2DS2VASc and HAS-BLED score provide more accurate means for assessment of the risk of stroke and bleeding than the CHADS2 and the previous bleeding risk scores, respectively. In addition, he emphasized that aspirin is neither effective nor safe in management of patients with AF.

New preventive strategies: drugs and devices

As a natural continuation to the previous presentations, Prof. Neuzil described the new pharmacological and interventional stroke prevention strategies. The direct thrombin inhibitor, dabigatran, was recently approved for prevention of stroke in patients with AF. The other drugs close to clinical approval include factor Xa inhibitors rivaroxaban and abixaban. According to the speaker, left atrial appendage closure may be a feasible alternative in patients with contraindication to OAC, in elderly patients with high bleeding risk and in post-ablation patients with high risk of stroke.

Anticoagulation after ablation: what is optimal?

Dr. Mavrakis discussed the role of anticoagulation after AF ablation. According to the current Guidelines, it is recommended to use OAC for 2-3 months after ablation in all patients. Thereafter the need of OAC depends on the risk factors of stroke. Dr. Mavrakis concluded that OAC should not be stopped after ablation in patient with CHADS2 score ≥ 2.

In conclusion, the session nicely summarized currently available data on antithrombotic policies in patients with AF and provided important practical hints how to improve management of specific patient populations.

References


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Antithrombotic policies in atrial fibrillation patients

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.