Atrial fibrillation secondary prevention
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Sinus rhythm  |
Atrial fibrillation  | |
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| ICD-10 | I48 |
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| ICD-9 | 427.31 |
| DiseasesDB | 1065 |
| MedlinePlus | 000184 |
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Atrial Fibrillation Microchapters | |
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Cardioversion | |
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Anticoagulation | |
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Atrial fibrillation secondary prevention On the Web | |
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Directions to Hospitals Treating Atrial fibrillation secondary prevention | |
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Risk calculators and risk factors for Atrial fibrillation secondary prevention | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Synonyms and related keywords: AF, Afib, fib
Overview
ACCF/AHA/HRS 2011 Guidelines - Atrial Fibrillation - Secondary Prevention with Thromboembolism Prevention (DO NOT EDIT) [1]
| Class I |
| "1.Antithrombotic therapy to prevent thromboembolism is recommended for all patients with AF, except those with lone AF or contraindications. (Level of Evidence: A) " |
| "2. The antithrombotic agent should be chosen based upon the absolute risks of stroke and bleeding and the relative risk and benefit for a given patient. (Level of Evidence: A) " |
| "3. For patients at high risk of stroke, chronic oral anticoagulant therapy with a vitamin K antagonist (INR 2.0 to 3.0) is recommended, unless contra-indicated. Factors associated with highest risk for stroke in patients with AF are prior stroke, TIA, or systemic embolism, rheumatic mitral stenosis and a mechanical heart valve. (Level of Evidence: A) " |
| "4.Anticoagulation with a vitamin K antagonist is recommended for patients with more than 1 moderate risk factor (age >75 years, hypertension, diabetes mellitus, HF, or impaired LV systolic function [ejection fraction ≥ 35% or fractional shortening < 25%]). (Level of Evidence: A) " |
| "5.INR should be determined at least weekly during initiation of therapy and monthly when stable. (Level of Evidence: A) " |
| "6. Aspirin, 81–325 mg daily, is recommended in low-risk patients or in those with contraindications to oral anticoagulation. (Level of Evidence: A) " |
| "7. For patients with AF who have mechanical heart valves, the target intensity of anticoagulation should be based on the type of prosthesis, maintaining an INR of at least 2.5. (Level of Evidence: B) " |
| "8. Antithrombotic therapy is recommended for patients with atrial flutter as for AF. (Level of Evidence: C) " |
| "9. Dabigatran is useful as an alternative to warfarin for the prevention of stroke and systemic thromboembolism in patients with paroxysmal to permanent AF and risk factors for stroke or systemic embolization who do not have a prosthetic heart valve or hemodynamically significant valve disease, severe renal failure (creatinine clearance <15 mL/ min) or advanced liver disease (impaired baseline clotting function). (Level of Evidence: B) " |
| Class III |
| "1. Long-term anticoagulation is not recommended for primary stroke prevention in patients below age 60 years without heart disease (lone AF).(Level of Evidence: C) " |
| Class IIa |
| "1. For primary prevention of thromboembolism in patients with nonvalvular AF who have just 1 of the validated risk factors (age >75 years (especially in female patients), hypertension, diabetes mellitus, HF, or impaired LV function), antithrombotic therapy with either aspirin or a vitamin K antagonist is reasonable, based upon an assessment of the risk of bleeding complications, ability to safely sustain anticoagulation, and patient preferences. (Level of Evidence: A) " |
| "2. For patients with nonvalvular AF who have 1 or more of the less well-validated risk factors (age 65-74 years, female gender, or CAD), treatment with either aspirin or a vitamin K antagonist is reasonable. (Level of Evidence: B) " |
| "3. It is reasonable to select antithrombotic therapy using the same criteria irrespective of the pattern (paroxysmal, persistent, or permanent) of AF. (Level of Evidence: B) " |
| "4. In patients with AF without a mechanical heart valve, it is reasonable to interrupt anticoagulation for up to 1 wk for procedures that carry a risk of bleeding. (Level of Evidence: C) " |
| "5. It is reasonable to re-evaluate the need for anticoagulation at regular intervals. (Level of Evidence: C) " |
| Class IIb |
| "1. In patients 75 years of age and older at risk of bleeding but without contraindications to anticoagulant therapy, and in patients who are unable to safely tolerate standard anticoagulation (INR 2.0 to 3.0), a lower INR target (2.0;
range 1.6 to 2.5) may be considered for primary prevention of stroke and systemic embolism. (Level of Evidence: C) " |
| "2. When interruption of oral anticoagulant therapy for longer than 1 wk is necessary in high-risk patients, unfractionated or low-molecular-weight heparin may be given by injection, although efficacy is uncertain. (Level of Evidence: C) " |
| "3. Following coronary revascularization in patients with AF, low-dose aspirin (<100 mg daily) and/or clopidogrel (75 mg daily) may be given concurrently with anticoagulation, but these strategies are associated with an increased risk of bleeding. (Level of Evidence: C) " |
| "4. In patients undergoing coronary revascularization, anticoagulation may be interrupted to prevent bleeding, but should be resumed as soon as possible after the procedure and the dose adjusted to achieve a therapeutic INR. Aspirin may be given during the hiatus. For patients undergoing percutaneous intervention, the maintenance regimen should consist of clopidogrel, 75 mg daily, plus warfarin (INR 2.0 to 3.0). Clopidogrel should be given for a minimum of 1 mo after a bare metal stent, at least 3 mo for a sirolimus-eluting stent, at least 6 mo for a paclitaxeleluting stent, and 12 mo or longer in selected patients, followed by warfarin alone. (Level of Evidence: C) " |
| "5. In patients with AF who sustain ischemic stroke or systemic embolism during treatment with anticoagulation (INR 2.0 to 3.0), it may be reasonable to raise the intensity of anticoagulation up to a target INR of 3.0 to 3.5. (Level of Evidence: C) " |
| "6. The addition of clopidogrel to aspirin to reduce the risk of major vascular events, including stroke, might be considered in patients with AF in whom oral anticoagulation with warfarin is considered unsuitable due to patient preference or the physician’s assessment of the patient’s ability to safely sustain anticoagulation. (Level of Evidence: B) " |
ACCF/AHA/HRS 2011 Guidelines - Atrial Fibrillation - Secondary Prevention with Pacing (DO NOT EDIT) [2][3]
| Class III |
| "1. Permanent pacing is not indicated for the prevention of AF in patients without any other indication for pacemaker implantation. (Level of Evidence: B)" |
Vote on and Suggest Revisions to the Current Guidelines
Guideline Resources
- 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation [3]
- ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter [4]
References
- ↑ Wann LS, Curtis AB, Ellenbogen KA, Estes NA, Ezekowitz MD, Jackman WM; et al. (2011). "2011 ACCF/AHA/HRS focused update on the management of patients with atrial fibrillation (update on Dabigatran): a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines". Circulation. 123 (10): 1144–50. doi:10.1161/CIR.0b013e31820f14c0. PMID 21321155.
- ↑ 2.0 2.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines 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 European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
- ↑ 3.0 3.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
- ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199
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