atrial fibrillation warfarin and its newer alternatives l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Atrial Fibrillation Warfarin and its newer alternatives PowerPoint Presentation
Download Presentation
Atrial Fibrillation Warfarin and its newer alternatives

Loading in 2 Seconds...

play fullscreen
1 / 29

Atrial Fibrillation Warfarin and its newer alternatives - PowerPoint PPT Presentation


  • 258 Views
  • Uploaded on

Atrial Fibrillation Warfarin and its newer alternatives. Dr Mark Abelson Cardiologist Somerset West. Association of AF and Stroke. MM00453 (01) Intl 06/09. Occluded Left ICA-T Pre and Post Embolectomy. 54y M, “Wake up” >4h,NIHSS=32. MRS=1 @ 90 d. Carotid Embolectomy. AF and Stroke.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Atrial Fibrillation Warfarin and its newer alternatives' - kacy


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
atrial fibrillation warfarin and its newer alternatives

Atrial Fibrillation Warfarin and its newer alternatives

Dr Mark Abelson

Cardiologist

Somerset West

slide8

Association of AF

and Stroke

MM00453 (01) Intl 06/09

occluded left ica t pre and post embolectomy
Occluded Left ICA-T Pre and Post Embolectomy

54y M, “Wake up” >4h,NIHSS=32

MRS=1 @ 90 d

slide12

AF and Stroke

AtrialFibrillation and Stroke

  • 3 million in US and 4.5 million in the EU have AF
  • 2/3 of AF population are at high-risk of stroke
  • AF is responsible for 15-20% of ischemic strokes
  • AF Incidence increases with age
  • -- 0.4% in general population
    • -- 0.2% of 25-34 yrs of age
    • -- 2-5% of >60 yrs of age
    • -- 10% of > 80 yrs of age
slide14

Risk Stratification and Annual Stroke Risk for Patients with AF

Annual Stroke Risk for Patients with AF

By CHADS(2) Score

F GAGE et al., 2004; 110:2287-2292

slide15

Clot Prevention

Currently Available Management Options

  • Medical Management: Anticoagulant
  • Effective: 67% stoke risk reduction(1)
  • Narrow therapeutic window for proper dose
  • Contraindicated in 14-47% of patients at risk of stroke (2)
  • Major complication: bleeding
  • Surgical Excision (Appendectomy)
  • Residual shunt: 10% (3)
  • Inconsistent outcomes due to incomplete exclusion;
  • Can create pouch with stagnant blood flow (4,5)
  • High invasiveness
  • Transcatheter Device Closure
  • Minimally invasive nature
  • Designed for percutaneous closure of the LAA in

prevention of clot embolization that may form in the

LAA

  • Intended as an alternative to warfarin therapy for

patients with non-valvular atrial fibrillation

slide16

Warfarin Therapeutic Window - INR of 2 to 3

A small window:

difficult to achieve

a well controlled

therapeutic range

inr control not good
INR Control – Not Good

Low INR <1.6

Efficacy  4-fold

TherapeuticINR 2-3

High INR >3.2

%

Bungard: Pharmacotherapy 20:1060, 2001

3000838-14

new warfarin alternatives
New Warfarin Alternatives
  • NO INR monitoring

- Dabigatran ( Pradaxa) – direct thrombin inhibitor

- Rivaroxaban (Xarelto) – F10a inhibitor

  • Aspirin plus clopidogrel
  • Aspirin (reduces stroke risk by 20%)
slide20

Risk of Stroke or Embolism

Connolly SJ et al. N Engl J Med 2009;361:1139-1151.

can t take warfarin
Can’t Take Warfarin??
  • Frail, falls
  • GI bleeds
  • Cerebral bleeds
  • Stroke despite therapeutic warfarin
  • Non-compliant / labile INR
  • (Do not want warfarin)
left atrial appendage occluders
Left Atrial Appendage Occluders

Transcatheter Occlusion of the LAA

Currently available in limited markets

AMPLATZER® Cardiac Plug WATCHMAN®

vergelegen experience
Vergelegen Experience
  • 7 patients – all elderly men with Chads>2
  • Significant GI bleeds on warfarin
  • Warfarin stopped – 2 had small strokes
  • One INR very labile due to recurrent UTI (antibiotics. Suprapubic catheter)
  • All discharged next day – ASA and plavix for 1 month then ASA alone.