scholarly journals Focused Update on Primary Stroke Prevention in Patients with Atrial Fibrillation in Korean Clinical Practice Guidelines for Stroke

2012 ◽  
Vol 14 (3) ◽  
pp. 106 ◽  
Author(s):  
Jong-Moo Park ◽  
Keun-Sik Hong ◽  
Sang Won Han ◽  
Hahn Young Kim ◽  
Yong-Jin Cho ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Stroke Prevention

scholarly journals Amiodarone for Atrial Fibrillation Following Cardiac Surgery: Development of Clinical Practice Guidelines at a University Hospital

2008 ◽  
Vol 31 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Ujjaini Khanderia ◽  
Deborah Wagner ◽  
Paul C. Walker ◽  
Brian Woodcock ◽  
Richard Prager
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
University Hospital

Primary Stroke Prevention in Nonvalvular Atrial Fibrillation: Implementing the Clinical Trial Findings

1997 ◽  
Vol 31 (10) ◽  
pp. 1187-1196 ◽  
Author(s):  
Patricia A Howard ◽  
Pamela W Duncan
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trial ◽  
Clinical Trials ◽  
Clinical Practice ◽  
Cost Effectiveness ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Randomized Clinical Trials ◽  
Nonvalvular Atrial Fibrillation ◽  
Risk Patients

OBJECTIVE: To review the clinical trials evaluating warfarin for primary stroke prophylaxis in nonvalvular atrial fibrillation (NVAF), to discuss the relative benefits and risks of warfarin versus aspirin therapy, and to review the clinical practice guidelines and identify potential barriers to their implementation in clinical practice. DATA SOURCES: A MEDLINE literature search was performed to identify clinical trials of antithrombotic therapy for NVAF, clinical practice guidelines, studies evaluating physician practices and attitudes, cost-effectiveness studies, and pertinent review articles. Key search terms included atrial fibrillation, stroke, antithrombotic, warfarin, aspirin, and cost-effectiveness. DATA EXTRACTION: Prospective, randomized clinical trials were selected for analysis. Clinical practice guidelines from recognized panels of experts were reviewed. Comprehensive review articles were selected. DATA SYNTHESIS: NVAF is a common arrhythmia that is associated with a substantial risk for stroke. Seven prospective, randomized, clinical trials have conclusively demonstrated the efficacy of warfarin for stroke prevention. The greatest benefits are achieved in older patients and those with comorbidities that increase their risk for stroke. The potential benefits of preventing a devastating stroke, however, must be weighed against the potential for bleeding complications. Warfarin has been shown to be cost-effective in high-risk patients, provided the rate of complications is minimized. Nonetheless, many physicians remain hesitant to implement warfarin therapy in older, high-risk patients. The clinical data on aspirin are less consistent than those observed with warfarin. Aspirin appears to be most effective in younger individuals or those considered to be at low risk for stroke. CONCLUSIONS: In patients with NVAF, the personal, social, and economic consequences of stroke are often devastating. Clinical trials have provided definitive proof that the risks of stroke can be significantly reduced through the use of appropriate antithrombotic therapy. Despite this evidence and the recommendations of a number of clinical practice guidelines, variations in care exist that continue to place patients at risk. Additional outcomes research is needed to evaluate the impact of the clinical trial findings and practice guidelines on clinical practice and to develop methods for overcoming barriers to implementation.

Representation of Females in Atrial Fibrillation Clinical Practice Guidelines

2022 ◽  
Author(s):  
Pouria Alipour ◽  
Zahra Azizi ◽  
Colleen M. Norris ◽  
Valeria Raparelli ◽  
M. Sean McMurtry ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines

scholarly journals Current clinical practice guidelines in atrial fibrillation: a review

Medwave ◽  
2016 ◽  
Vol 16 (01) ◽  
pp. e6365-e6365 ◽  
Author(s):  
José Kelvin Galvez-Olortegui ◽  
Mayita Lizbeth Álvarez-Vargas ◽  
Tomas Vladimir Galvez-Olortegui ◽  
Armando Godoy-Palomino ◽  
Luis Camacho-Saavedra
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Current Clinical Practice

scholarly journals 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation: what is new for neurologists?

2021 ◽  
Vol 27 (1) ◽  
pp. 7-15
Author(s):  
S. N. Yanishevskiy ◽  
I. B. Skiba ◽  
A. Y. Polushin
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Anticoagulant Therapy ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cryptogenic Stroke ◽  
Original Position ◽  
Diagnosis And Management ◽  
Esc Guidelines ◽  
European Society Of Cardiology

Clinical practice guidelines for the diagnosis and management of atrial fibrillation (AF) are one of the most regularly updated documents by the European Society of Cardiology. The new version of clinical practice guidelines (2020) contains a number of changes regarding anticoagulant therapy in patients with AF who have developed acute cerebrovascular accidents. In this review, we discuss the statements of the updated document on the timing of the start/restart of anticoagulant therapy after ischemic stroke and intracranial hemorrhage in patients with AF, the choice of antithrombotic therapy in patients with cryptogenic stroke, as well as the need for the additional testing to clarify the origin of the embolism. We provide our original position on the possibility of applying these recommendations to the real clinical practice.

scholarly journals The Peri-Operative Management of Anticoagulants: Systemic Review of Guidelines

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4974-4974
Author(s):  
Salma Shivji ◽  
Philip Chiang ◽  
Lana A Castellucci ◽  
Elianna Saidenberg
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Bleeding Risk ◽  
Operative Management ◽  
Anticoagulation Management ◽  
Thrombotic Risk ◽  
Reversal Agents

Introduction Venous thromboembolism (VTE) and atrial fibrillation are thrombotic disorders resulting in significant morbidity and mortality, if left untreated. In Canada, 45,000 people, or 1-2 cases per 1000 people, per year will experience an acute VTE, and it is estimated that 200,000 Canadians have atrial fibrillation. The treatment of VTE and atrial fibrillation often includes the use of anticoagulants. Patients on anticoagulation may need interruption of treatment for surgeries and procedures. To evaluate differences in perioperative anticoagulation management strategies we conducted a systematic review of the peri-operative clinical practice guidelines for anticoagulants. Methods A protocol using the Preferred Reporting Items for Systematic review and Meta-analysis Protocols (PRISMA-P) was developed. Relevant primary clinical practice guidelines were identified using MEDLINE, EMBASE, and guideline-specific databases. All guidelines from the preceding 20 years up to January 11, 2019 were screened. Eligible manuscripts were reviewed by two independent reviewers. Data abstraction was independently completed in duplicate for included guidances and categorized according to thrombotic risks and bleeding risks. Guidances on emergency surgeries were not included for the purposes of this review. Information on anticoagulation interruption, bridging regimens, laboratory testing, and reversal strategies were collected. Results Eight guidelines met inclusion criteria and 6 contained sufficient information for peri-operative management of anticoagulants. One guideline focused on patients presenting with bleeding events and restated the same peri-operative guidelines as had been published a year prior by the same group, and was excluded. Another guideline only addressed emergency surgeries and was also excluded from this review. The majority of the guidelines had similar definitions of risk factors for venous and arterial thrombotic events (see table 1). There were no conflicting guidance recommendations identified, but there were differences in the component of peri-operative management addressed by each guideline, ie bridging, reversal agents, laboratory tests. The levels of evidence used to develop recommendations varied between guidelines. All guidelines provided recommendations on warfarin and low molecular weight heparins (LMWH) management and only one guideline provided suggestions for direct oral anticoagulants (DOACs). The findings for perioperative anticoagulation management for patients with atrial fibrillation and VTE are presented in Tables 2 and 3, respectively. For high bleeding risk surgeries, most guidelines cited similar studies resulting in similar recommendations for interruption of warfarin and bridging in high venous and arterial thrombotic risk patients. In high bleeding risk procedures and low thrombotic risk patients, no bridging is recommended. For low bleed risk procedures, regardless of thrombotic risk, guidelines recommended for continuation of anticoagulant therapy. Discussion This systematic review identified 6 guidelines of non-urgent peri-operative management recommendations of primarily warfarin and LMWH in patients with VTE and atrial fibrillation. While no major discrepancies in the guideline suggestions were noted, the scope of data examined (medication management, bridging, blood tests, reversal of agents) differed amongst the various agencies. The guidelines that were most consistent for recommendations of anticoagulant management and bridging tended to be from hematologic societies. The only guideline that addressed perioperative management of DOACs was the 2018 ASH guideline on management of VTE which was against measurement of DOAC levels prior to procedures. The lack of thorough guidance for DOACs is likely due to the year of publication of the guidelines examined and paucity of contributing studies. In terms of reversal agents, all clinical practice guidelines except for the ASH guidelines were prior to specific DOAC reversal agents such as idaracizumab. Future Directions We anticipate that there will be other guidelines developed that address specifically the use of DOACs in the perioperative setting, as well as their reversal agents. Disclosures Shivji: BMS-Pfizer Thrombosis Canada: Other: Fellowship award. Castellucci:BMS: Honoraria; Pfizer: Honoraria; Bayer: Honoraria; LEO Pharma: Honoraria; Sanofi: Honoraria; Aspen: Honoraria; Servier: Honoraria.

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