Our mission is to become a worldwide reference for education in the field for all professionals involved in the process to disseminate knowledge & skills of Acute Cardiovascular Care.
Our mission is to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging in Europe.
Our mission is to promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.
Our mission is to reduce the burden of cardiovascular disease through percutaneous cardiovascular interventions.
Improving the quality of life and reducing sudden cardiac death by limiting the impact of heart rhythm disturbances.
Our mission is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
The ESC Working Groups' goal is to stimulate and disseminate scientific knowledge in different fields of cardiology.
The ESC Councils' goal is to share knowledge among medical professionals practising in specific cardiology domains.
Prof. Gregory Y. H. Lip
View the Slides from this session in ESC Congress 365
This session was chaired by me and Francisco Marin (Spain).
Pierre Amaarenco (France) opened the session by providing an overview – from the stroke physicians perspective – on what to do when a patient gets thromboembolic events despite well controlled warfarin. Good time in therapeutic range is essential, and the possibility to swop to a Non-VKA Oral Anticoagulant (NOAC, previously referred to as new or novel OACs ) may offer better protection. Left atrial appendage occlusion devices could be considered in the small minority of patients at high stroke recurrence who are also at high bleeding risk. In addition risk factors should be addressed, including carotid disease, hypertension etc.
J M. Ten Berg (Nieuwegein, NL) provided an overview of challenges and evidence, and highlighted the recent publication of the 2014 European joint consensus document, from the ESC Working Group on Thrombosis, EHRA, EAPCI and ACCA, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society . He reviewed the new evidence for concomitant oral anticoagulation plus antiplatelet therapy use from observational studies, the one randomized trial (WOEST) and the data from the NOACs. Ongoing randomized trials (PIONEER-AF, RE-DUAL PCI, etc) will provide additional data.
J Oldgren (Sweden) discussed the patient on anticoagulants presents with an ischaemic stroke. With NOACs there are simple tests to check whether the patient is systemically anticoagulated or not. Also, limited data exist on when to restart oral anticoagulation following an acute presentation, but expert consensus suggests that this could be related to severity of stroke, eg. 1 day after a TIA, 3 days after a mild stroke, 6 days after a moderate stroke, 12-14 days after a severe stroke. Longer may be needed after a very large stroke due to risk of haemorrhagic transformation.
Finally, G Hindricks, (Germany) discussed the patient on new anticoagulants needs an interventional procedure, specifically devices, surgery and ablation. The NOACs have a short half-life and after appropriate time of withdrawal most of the drug should be out of the system and an operation can be performed
Overall, an informative educational session dealing with many practical aspects – as reflected by many questions asked by the audience.
1. Lip GY, Windecker S, Huber K, Kirchhof P, Marin F, Ten Berg JM, Haeusler KG, Boriani G, Capodanno D, Gilard M, Zeymer U, Lane D; Document Reviewers, Storey RF, Bueno H, Collet JP, Fauchier L, Halvorsen S, Lettino M, Morais J, Mueller C, Potpara TS, Rasmussen LH, Rubboli A, Tamargo J, Valgimigli M, Zamorano JL. Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur Heart J. 2014 Aug 25. pii: ehu298. [Epub ahead of print]
SessionTitle: Practical aspects on stroke prevention in atrial fibrillation
Our mission: To reduce the burden of cardiovascular disease
© 2017 European Society of Cardiology. All rights reserved