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The treatment of atrial fibrillation includes anticoagulation, rate control, and rhythm control. New US guidelines for the management of atrial fibrillation have recently been published.1
Atrial fibrillation increases the risk of thromboembolic stroke. Anticoagulant therapy reduces this risk, but it can cause intracranial and other serious bleeding. The risk of bleeding must be weighed against the benefit of thromboembolic risk reduction.
A new scoring system, the CHA2DS2-VASc score, has been designed to aid in this assessment for patients with nonvalvular atrial fibrillation. An algorithm from the recent US guidelines recommends oral anticoagulant treatment for patients who have a CHA2DS2-VASc score ≥2. For patients with a CHA2DS2-VASc score of 0, who have a very low risk of thromboemboli,... more
- CT January et al. 2014 AHA/ACC/HRS guideline 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 Heart Rhythm Society. Circulation 2014 April 10 (epub).
- AJ Camm et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012; 33:2719.
- SJ Connolly et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361:1139.
- MR Patel et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365:883.
- CB Granger et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365:981.
- Dabigatran etexilate (Pradaxa) – a new oral anticoagulant. Med Lett Drugs Ther 2010; 52:89.
- MR Southworth et al. Dabigatran and postmarketing reports of bleeding. N Engl J Med 2013; 368:1272.
- FDA. Pradaxa (dabigatran): drug safety communication – lower risk for stroke and death, but higher risk for GI bleeding compared to warfarin. Available at http://www.fda.gov. Accessed June 26, 2014.
- Inhibitors and inducers of CYP enzymes and P-glycoprotein. Med Lett Drugs Ther 2013; 55:e44.
- Rivaroxaban (Xarelto) – a new oral anticoagulant. Med Lett Drugs Ther 2011; 53:65.
- Kcentra: a 4-factor prothrombin complex concentrate for reversal of warfarin anticoagulation. Med Lett Drugs Ther 2013; 55:53.
- Apixaban (Eliquis) - a new oral anticoagulant for atrial fibrillation. Med Lett Drugs Ther 2013; 55:9.
- SM Al-Khatib et al. Rate- and rhythm-control therapies in patients with atrial fibrillation: a systematic review. Ann Intern Med 2014; 160:760.
- IC Van Gelder et al. Lenient versus strict rate control in patients with atrial fibrillation: a systemic review. N Engl J Med 2010; 362:1363.
- Safety of dronedarone (Multaq). Med Lett Drugs Ther 2011; 53:103.
- Combined list of all QTdrugs and the list of drugs to avoid for patients with congenital long QT syndrome. Available at http://crediblemeds.org. Accessed June 26, 2014.