Atrial fibrillation medical therapy in patients presenting with ACS and/or PCI or valve intervention
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Atrial fibrillation medical therapy in patients presenting with ACS and/or PCI or valve intervention On the Web | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
2014 Management of Antithrombotic Therapy in AF Patients Presenting with ACS and/or Undergoing PCI or Valve Interventions: A Joint Consensus Document (DO NOT EDIT)[1]
General
| Class I |
| "1. In AF patients, stroke risk must be assessed using the CHA2-DS2-VASc score, and bleeding risk assessed using the HAS-BLED score.2 Risk stratification is a dynamic process, and must be performed at regular intervals (i.e. on a yearly basis). (Level of Evidence: C)" |
| "2. Where adjusted dose VKA is used, good quality anticoagulation control is recommended, with a TTR >70%. (Level of Evidence: A)" |
| Class III |
| "1. Novel P2Y12 receptor inhibitors (prasugrel and ticagrelor) should not be part of a triple therapy regimen in patients with AF. (Level of Evidence: C)" |
| Class IIa |
| "1. When VKA is given in combination with clopidogrel and/or low-dose aspirin, the dose intensity of VKA should be carefully regulated, with a target INR range of 2.0–2.5. (Level of Evidence: Grade C)" |
| "2. In a patient with AF and stable vascular disease (arbitrarily defined as being free from any acute ischaemic event or repeat revascularization for >1 year) the patient should be managed with OAC alone (i.e. whether NOAC or a VKA). (Level of Evidence: Grade B)" |
| "3. Radial access should be considered as the default for coronary angiography/intervention to minimize the risk of access related bleeding depending on operator expertise and preference. (Level of Evidence: Grade C)" |
| Class IIb |
| "1. Where aNOACis used in combination with clopidogrel and/or low-dose aspirin, the lower tested dose for stroke prevention in AF (that is, dabigatran 110 mg b.i.d., rivaroxaban 15 mg o.d. or apixaban 2.5 mg b.i.d.) may be considered (Prescribing information for edoxaban awaited.). (Level of Evidence: Grade C)" |
| "2. Newgeneration DES may be preferred over BMS in patients at low risk of bleeding (i.e. HAS-BLED 0–2). (Level of Evidence: Grade C)" |
Stable CAD
NSTE-ACS Including Unstable Angina and NSTEMI
Primary PCI
Application to General Anticoagulated Patients Who May or May Not Have AF
References
- ↑ Task Force Members. Lip GY, Windecker S, Huber K, Kirchhof P, Marin F; et al. (2014). "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. doi:10.1093/eurheartj/ehu298. PMID 25154388.