Magazine article Drug Topics

Oral Anticoagulation May Not Benefit All AF Patients

Magazine article Drug Topics

Oral Anticoagulation May Not Benefit All AF Patients

Article excerpt


Patients with atrial fibrillation (AF) and ¿1 point on the CHA2DS2-VASc (congestive heart failure, hypertension, age ¿75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex) stroke risk scale are considered at increased risk of future stroke, but the risk associated with a score of 1 differs markedly between studies.

A new retrospective review suggests that patients with AF who have a CHA2DS2-VASc score of 1 may not benefit from anticoagulation therapy. The Swedish study included 140,420 patients with AF. The goal of the review was to assess the risk of AF-related stroke among patients with a score of 1 on the CHA2DS2-VASc . The researchers used a broad definition of stroke diagnosis (hospital discharge diagnoses of ischemic stroke, unspecified stroke, transient ischemic attack, and pulmonary embolism) and found a 44% higher annual risk than when only ischemic strokes were counted. When stroke events were included in conjunction with the index hospitalization for AF, the long-term risk was doubled beyond the first four weeks. Overall, depending on which event definition was used, the annual stroke rates varied between 0.1% and 0.2% for women and between 0.5% and 0.7% for men.

The authors concluded that in light of the low risk of stroke in this study, AF patients <65 years of age but with a CHA2DS2-VASc score of 1 are unlikely to benefit from anticoagulation therapy.

Source: Friberg L, Skeppholm M, TermtA. Bmefit of anticoagulation unlikely in patimts with atrial fibrillation and a CFLA2DS2-VASc Score of 1. J Am Coll Cardiol. 2015;65(3):225-232.

NOACs require careful attention in the ICU

A small study of 21 patients in the intensive care unit showed that a high percentage of patients on novel oral anticoagulants (NOACs) receive inappropriate doses of the drugs at some point during their stay. Patients typically receive these medications for stroke prevention in atrial fibrillation.

Failure to adjust for renal function was implicated in six of the seven cases in which problems were identified. NOACs are an attractive treatment option owing to the rapid onset and conclusion of their action, lack of need for routine coagulation monitoring, and fewer drug and food interactions, but renal function can change rapidly in this patient population. NOACs require dose adjustments to prevent bleeding problems in patients with moderate renal dysfunction and should be completely avoided in cases of end-stage renal disease. …

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