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Anti-thrombotic therapy in atrial fibrillation - difficult management scenarios

Session presentations
  • The 74 year old man with peripheral artery disease - how to assess risks of stroke, bleeding and falls. Presented by F Marin (Murcia, ES) See the slides  Watch the webcast
  • Panel discussion. Presented by A Bollmann (Leipzig, DE), F Marin (Murcia, ES), L H Rasmussen (Aalborg, DK)
  • The young female patient undergoing AF ablation - should we anticoagulate? Presented by A Bollmann (Leipzig, DE) See the slides  Watch the webcast
  • Panel discussion. Presented by A Bollmann (Leipzig, DE), F Marin (Murcia, ES), L H Rasmussen (Aalborg, DK)
  • What do the Guidelines say? Presented by G Y H Lip (Birmingham, GB)
Atrial Fibrillation


This Meet the Expert session was chaired by G.Y.H. Lip (Birmingham, GB) and L. Friberg (Stockholm, SE),  accompanied by expert panellists, Dr F Marin (Spain), Dr L H Rasmussen (Denmark) and Dr A Bollmann (Germany).

Dr Marin presented a case of the 74 year old man with peripheral artery disease - how to assess risks of stroke, bleeding and falls. This led to lively discussion on the importance of the CHA2DS2-VASc score over CHADS2, as well as the independent additive effect of peripheral artery disease to the predictive value of the CHADS2 score [1].

Bleeding risk is assessed by the HAS-BLED score, and has been well-validated in recent studies, even being superior to other scores (including the ATRIA score) [2,3,4].

Dr Bollmann discussed a case of the young female patient undergoing AF ablation - should we anticoagulate?   Recent studies have shown that female patients overall have an increased risk of stroke in AF, but there is an age effect [5,6].  If a female patient fulfils the criteria of ‘age <65 and lone AF’ their risk of stroke is so low, that antithrombotic therapy is not recommended.  The recent joint guidelines following ablation therapy were discussed [7].

Prof  Lip closed the session with a presentation on ‘What do the Guidelines say?’ with particular reference to the new 2012 focused update guidelines on AF management [8], published and presented at this meeting.  The important point in this guideline is the practice shift towards identification of ‘truly low risk’ patients with AF who do not need any antithrombotic therapy, whilst those with one or more stroke risk factors can be offered effective stroke prevention, which is oral anticoagulation therapy whether with well controlled warfarin (INR 2-3) or one of the novel anticoagulant drugs.

REFERENCES
1. Olesen J et al Am J Med 2012 August
2. Apostolakis S et al. J Am Coll Cardiol 2012 August
3. Roldan V et al Chest 2012
4. Lip GYH et al Circulation Arrhythmias and Electrophysiology 2012
5. Friberg L et al BMJ 2012
6. Olesen et al Chest 2011
7. Calkins H et al 2012
8. Camm AJ et al Eur Heart J 2012

References


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Anti-thrombotic therapy in atrial fibrillation - difficult management scenarios

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.