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Reducing Stroke Risk in Atrial Fibrillation

Reducing Stroke Risk in Atrial Fibrillation. Kousik Krishnan, MD, FACC, FHRS Associate Professor of Medicine & Pediatrics Rush University Medical Center Director, Clinical Cardiac Electrophysiology Fellowship Program. Atrial Fibrillation 2 Problems.

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Reducing Stroke Risk in Atrial Fibrillation

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  1. Reducing Stroke Risk in Atrial Fibrillation Kousik Krishnan, MD, FACC, FHRS Associate Professor of Medicine & Pediatrics Rush University Medical Center Director, Clinical Cardiac Electrophysiology Fellowship Program

  2. Atrial Fibrillation2 Problems Symptoms - you feel palpitations, shortness of breath, etc. Risk of stroke: “Silent Risk”

  3. AF increases Stroke Risk 5x • Roger VL et al. Circulation. 2012;125:e2-e220. • Wolf PA et al. Stroke. 1991;22(8):983-988. 2-year Age-adjusted Incidence of Stroke According to Presence of NVAF2 (Framingham Heart Study)

  4. Rate of DeathStroke pts with AF are at increased risk vs those without AF Marini C, Stroke 2005

  5. The Problem

  6. Why does this risk exist? Blood moves poorly in the upper chamber (atrium) Increased coagulation factors

  7. How do we reduce risk? Anticoagulation Anticoagulation Anticoagulation

  8. Options for Anticoagulation • Warfarin (Coumadin TM) • Novel Oral Anticoagulants (NOACs) • Pradaxa (Dabigatran) • Xarelto (Rivaroxaban) • Eliquis (Apixaban)

  9. Warfarin Reduces Risk by 60% >50 years of experience Blood checks to monitor effect Numerous med interactions Food interactions Inconvenient Dosing not uniform Inexpensive

  10. NOAC New –Experience <3 years Predictable effect- dosing uniform Less med interactions No food interactions Expensive Similar Efficacy to Coumadin Similar to slightly less bleeding risk

  11. How good do these work? Warfarin and NOACs reduce your risk of having a stroke by over 60%

  12. But… Because these meds all anticoagulate, they increase the risk of bleeding

  13. CHADS2 Score and Stroke Risk • Congestive Heart Failure • Hypertension • Age >75 • Diabetes Mellitus • Stroke/TIA (2 pts) Gage B, et.al, JAMA. 2001 Jun 13;285(22):2864-70.

  14. HAS-Bled Score and Bleeding Rates Pisters, et al, Chest. 2010 Nov;138(5):1093-100

  15. Future OptionsNew Horizons

  16. Percutaneous Closure

  17. What do we do? Assess individual stroke and bleeding risk Decide on the best option to reduce stroke

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