Prevention of stroke in patients with atrial fibrillation: current strategies and future directions

Hohnloser, Stefan H.; Duray, Gabor Z.; Baber, Usman; Halperin, Jonathan L.

doi:10.1093/eurheartj/sun029

Cited by 31 publications

(15 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Selection of antithrombotic therapy should be based on the risk of thromboembolism irrespective of whether the AF pattern is paroxysmal, persistent, or permanent. [42][43][44][45] (Class I, Level of Evidence: B)…”

mentioning

confidence: 99%

“…For patients with nonvalvular AF with prior stroke, transient ischemic attack (TIA), or a CHA 2 DS 2 -VASc score of 2 or greater, oral anticoagulants are recommended. Options include: warfarin (INR 2.0 to 3.0) [42][43][44][45] (Class I, Level of Evidence: A), dabigatran 52 (Class I, Level of Evidence: B), rivaroxaban 53 (Class I, Level of Evidence: B), or apixaban 54 (Class I, Level of Evidence: B).…”

mentioning

confidence: 99%

See 1 more Smart Citation

2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter

Heidenreich¹,

Solis²,

Estes³

et al. 2016

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

The American Heart Association requests that this document be cited as follows: Heidenreich PA, Solis P, Estes NAM 3rd, Fonarow GC, Jurgens CY, Marine JE, McManus DD, McNamara RL. 2016 ACC/AHA clinical performance and quality measures for adults with atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes. 2016;9:443-488. DOI: 10.1161/HCQ.0000000000000018. This article has been copublished in the Journal of the American College of Cardiology.Copies: This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org) and the American Heart Association (professional.heart.org). A copy of the document is available at http://professional.heart.org/statements by using either "Search for Guidelines & Statements" or the "Browse by Topic" area. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com.Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://professional.heart.org/statements. Select the "Guidelines & Statements" drop-down menu, then click "Publication Development."Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/CopyrightPermission-Guidelines_UCM_300404_Article.jsp. A link to the "Copyright Permissions Request Form" appears on the right side of the page. PreambleThe American College of Cardiology (ACC)/American Heart Association (AHA) clinical performance and quality measure sets serve as vehicles to accelerate translation of scientific evidence into clinical practice. Measure sets developed by the ACC/AHA are intended to provide practitioners and institutions that deliver cardiovascular services with tools to measure the quality of care provided and identify opportunities for improvement. Writing committees are instructed to consider the methodology of clinical performance measure development 1 and to ensure that the measures developed are aligned with ACC/AHA clinical guidelines. The writing committees also are charged with constructing measures that maximally capture important aspects of care quality, including timeliness, safety, effectiveness, efficiency, equity, and patient-centeredness, while minimizing, when possible, the reporting burden imposed on hospitals, practices, and practitioners. Potential challenges from measure implementation may lead to unintended consequences. The manner in which challenges are addressed is dependent on several factors, including the measure design, data collection method, performance attribution, baseline performance rates, reporting methods, and incentives linked to these reports.The ACC/AHA Task Force on Performance Measures d...

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter

Heidenreich¹,

Solis²,

Estes³

et al. 2016

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

show abstract

“…Obwohl der CHA 2 DS 2 VASc-Score zu einer besseren Identifizierung der Patienten im Niedrigrisikobereich, die von einer Antikoagulation profitieren können, beitragen dürfte, bestehen doch mehrere Limitationen, die bei der Entscheidung für oder gegen eine Antikoagulation im Einzelfall zu berücksichtigen sind [9]. So werden echokardiographische Parameter für die Risikobewertung (Flussgeschwindigkeit im linken Vorhofohr, spontaner Echokontrast, Vorhofthromben u. a. m.) nicht berücksichtigt [9,11].…”

Section: Nutzen-risiko-kalkulation Bei Antikoagulationunclassified

“…So werden echokardiographische Parameter für die Risikobewertung (Flussgeschwindigkeit im linken Vorhofohr, spontaner Echokontrast, Vorhofthromben u. a. m.) nicht berücksichtigt [9,11]. Schließlich werden auch im neu etablierten CHA 2 DS 2 VASc-Score nur die Schlaganfallrisiken, nicht aber die mit der Antikoagulation verbundenen Blutungsrisiken (frühere Blutung, Leber-/Nierenerkrankungen, Alkoholabhängigkeit, höheres Alter, Malignome, Thrombozytenzahl/-funktion, Hypertonie, Anämie, Sturzrisiko, frühere Schlaganfälle, genetische Faktoren) in Rechnung gestellt.…”

Section: Nutzen-risiko-kalkulation Bei Antikoagulationunclassified

Antikoagulation bei Vorhofflimmern

Volkmann

Walter

et al. 2011

Clin Res Cardiol Suppl

View full text Add to dashboard Cite

Morbidity and mortality associated with atrial fibrillation are mainly related to thromboembolic complications, particularly ischemic strokes. The prevention of thromboembolism is an important component of the management of patients with atrial fibrillation. The choice of optimum antithrombotic therapy for a given patient depends on the risk of thromboembolism, on the one hand, and the risk of intracerebral hemorrhage, on the other hand. Concerning the benefit-to-risk stratification, the problem lies in the similar and sometimes even identical risk factors for both thromboembolism and hemorrhage.At present, oral vitamin K antagonists are recommended for patients with atrial fibrillation at moderate or high risk of ischemic stroke. The thromboembolic risk should be assessed using validated stratification schemes, such as the CHADS(2) score for basic orientation and the CHA(2)DS(2)VASc score for extended risk stratification. Aspirin alone is recommended for patients at low risk of thromboembolic complications. Problems in antithrombotic therapy of atrial fibrillation arise treating those patients undergoing percutaneous coronary intervention and stent implantation, those with contraindication for vitamin K antagonists, or those with persisting left atrial thrombus requiring electrical cardioversion. The optimum therapeutic management of these special patients has not yet been defined by proper studies, leaving only empirically based recommendations for their treatment.Hopefully the development of new antithrombotic agents, that are easier to use and have a superior benefit-to-risk ratio, will extend effective prevention of thromboembolic events to a greater part of the atrial fibrillation population at risk.

show abstract

“…Obwohl der CHADS 2 -Score sich aufgrund seiner Einfachheit für die klinische Praxis anbietet und auch zunehmend benutzt wird, bestehen doch mehrere Limitationen, die bei der Entscheidung für oder gegen eine Antikoagulation im Einzelfall zu berück-sichtigen sind [11]. So werden stattgehabte Schlaganfälle bzw.…”

Section: Limitationen Des Chads 2 -Scoresunclassified