Anticoagulants

Atrial Fibrillation Management The central role of the GP

Opportunistic screening for atrial fibrillation (AF) is recommended for all patients aged over 65 years, and choosing between a rate and rhythm control strategy is important. Beta-blockers or nondihydropyridine calcium
channel antagonists are the first choice for rate control.
Flecainide is preferable for the pharmacologic rhythm control. The sexless CHA2DS2-VA assessment is recommended to assess stroke risk. Integrated care to support comprehensive treatment and address the specific needs of people with AF is required, and GPs are central to its effective delivery.

Modern Medicine – Issue 4 2020

August 14, 2020 by Peter Anticoagulants Atrial Fibrillation Cardiology

Stroke Prevention Medical interventions for everyday practice

Paroxysmal or permanent atrial fibrillation associated with a CHA2DS2-VASc score of one or more for men, and two or more for women should prompt consideration of anticoagulation to reduce stroke risk. High-risk patients with atrial fibrillation remain significantly undertreated. Older patients, despite having a high risk of falls, are nevertheless likely to benefit from anticoagulation. Perioperative bridging anticoagulation for patients with atrial fibrillation is not routinely recommended. Direct oral anticoagulant drugs should be ceased 24 to 48 hours before procedures. Asymptomatic carotid atherosclerotic disease should be treated medically. Antiplatelet medication for secondary prevention has most benefit when given early after stroke or transient ischaemic attack.

Modern Medicine – Aug/Sept 2018

September 26, 2018 by Peter Anticoagulants Cardiology Stroke

Study Reaffirms Low AF Stroke and Bleeding Rates

Study Reaffirms Low AF Stroke and Bleeding Rates – MM1701

Data from XAPASS – a prospective observational postauthorisation study, which enrolled more than 11 000 patients in Japan – confirmed low rates of both stroke and major bleeding in patients with non-valvular AF newly-initiated on rivaroxaban in routine clinical practice. These results were generally consistent with the Phase III J-ROCKET AF randomised clinical trial.

Modern Medicine – January 2017

January 27, 2017 by Peter Anticoagulants Stroke

Concepts and misconceptions in oral anticoagulation

Concepts and misconceptions in oral anticoagulation – MM1611

While there is still a place for vitamin K antagonists (VKAs)/warfarin in anticoagulation therapy, the direct oral anticoagulants or DOACs (previously termed the new oral anticoagulants or NOACs) offer an advantage in every possible respect.
This was the take-home message in a series of talks given recently by Professor Jan Beyer-Westendorf, head of the Thrombosis Research Unit at the Centre for Vascular Medicine, University Hospital ‘Carl Gustav Carus’ in Dresden, Germany. as a guest of Bayer. He stated categorically that nowadays he only uses VKAs in selected patients when it’s unavoidable.

Modern Medicine – November 2016

December 8, 2016 by Peter Anticoagulants Cardiology

TIAs and Stroke Prevention | Rapid Assessment, Urgent Treatment

TIAs and Stroke Prevention | Rapid Assessment, Urgent Treatment – MM1607

A transient ischaemic attack (TIA) is a transient neurovascular event that resolves within 24 hours without acute infarction on MRI. Urgent investigations for TIA or stroke should include: imaging of the brain; imaging of the carotid and vertebral arteries; 12-channel ECG and Holter monitoring; transthoracic echocardiography; blood pressure, fasting lipids and glucose measurements. The American Heart Association (AHA)/American Stroke Association (ASA) have updated their guidelines on primary and secondary stroke prevention, focusing on lifestyle changes and management of hypertension, hyperlipidaemia and diabetes. The targets for primary prevention are less strict than for secondary prevention but the same principles for treatment and lifestyle changes apply.

Modern Medicine – July 2016

July 22, 2016 by Peter Anticoagulants Cardiology Stroke

Practical Use of the Nonvitamin K Antagonist Oral Anticoagulants

Practical Use of the Nonvitamin K Antagonist Oral Anticoagulants – MM1606

NOACs (nonvitamin K antagonist oral anticoagulants) are an alternative to vitamin K antagonists such as warfarin for: prevention of stroke in patients with nonvalvular atrial fibrillation and of venous thromboembolism in adults after elective total hip or knee replacement; treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as prevention of recurrent DVT and PE.
The NOACs dabigatran and rivaroxaban differ in their properties, including mode of action and drug interactions; these differences must be taken into account when assessing patient suitability for NOAC therapy. Laboratory monitoring required for NOACs differs significantly from that used for warfarin. Perioperative use of NOACs is common but management differs between drugs, depending on their pharmacokinetic and pharmacodynamic properties.

Modern Medicine – June 2016

June 30, 2016 by Peter Anticoagulants

Anticoagulants

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