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Campagna Educazionale Nazionale ANMCO 2014 METEORITI SFIDARE L’ICTUS NELLA FIBRILLAZIONE ATRIALE

Campagna Educazionale Nazionale ANMCO 2014 METEORITI SFIDARE L’ICTUS NELLA FIBRILLAZIONE ATRIALE. STRATIFICAZIONE DEL RISCHIO E INDICAZIONI DELLE LINEE GUIDA. AC in NVAF Stroke Risk Reductions. Warfarin Better. Control Better. AFASAK. SPAF. BAATAF. CAFA. SPINAF. EAFT.

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Campagna Educazionale Nazionale ANMCO 2014 METEORITI SFIDARE L’ICTUS NELLA FIBRILLAZIONE ATRIALE

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  1. Campagna Educazionale Nazionale ANMCO 2014 METEORITI SFIDARE L’ICTUS NELLA FIBRILLAZIONE ATRIALE STRATIFICAZIONE DEL RISCHIO E INDICAZIONI DELLE LINEE GUIDA

  2. AC in NVAF Stroke Risk Reductions Warfarin Better Control Better AFASAK SPAF BAATAF CAFA SPINAF EAFT Aggregate -100% 50% -50% 100% 0 Hart R, et al. Ann Intern Med 1999;131:492

  3. Rischio tromboembolico nella FANV Rischio elevato Moderato Basso Età >75 anni Età 65-75 anni Età < 65 anni Pregresso TIA/ictus Diabete mellito (<60 anni**) o embolia sistemica Cardiopatia ischemica no cardiopatia Ipertensione arteriosa con FE conservata (FA lone) Disfunzione sistolica del ventricolo sinistro W o ASA * (in presenza di almeno 2 variabili preferire W) W+ASA ** ASA o niente W con INR 2-3* (>75 aa e rischio emorragico: INR 2)** 6th ACCP Consensus Conference, Chest 2001; 119 (S): 194-206 * ACC/AHA/ESC Guidelines, Circulation 2001; 104: 2118-50 **

  4. Stroke risk intermittent vs sustained AF Intermittent AF 14 Sustained AF 12 10 8 Annual risk of stroke (%) 6 4 2 0 Low risk Moderate risk High risk Hart RG et al. J Am Coll Cardiol 2000;35:183–7 Flaker GC et al. Am Heart J 2005;149:657–63

  5. CHADS2 index Classic Punteggio 0-6 punti Basso rischio 0 Rischio moderato 1-2 Alto rischio 3-6 Revised Punteggio 0-6 punti Basso rischio 0 Rischio moderato 1 Alto rischio 2-6 • Cardiac failure x 1 • Hypertension x 1 • Age >75 yrs x 1 • Diabetes x 1 • Stroke/TIA x 2 Gage BF, et al. JAMA 2001; 285: 2864-2870.

  6. ACCP Guidelines, Chest 2012

  7. CHADS2 Score: Validation for Predicting Stroke N= 1733 pts (65-95 yrs) Adjusted Stroke Rate % per year Gage BF et al, JAMA 2001; 285: 2864-2870

  8. Incidence of stroke or systemic embolism per year in large trials evaluating W vs NOACs CHADS2 2.1 CHADS2 3.4 CHADS2 2.1

  9. CHA2DS2 Vasc index Lip G, et al. Chest 2010; 137: 263-272

  10. Chao TF, Stroke 2012; 43: 2551-5

  11. CHA2DS2 - VAsc Score Validation for Predicting Stroke Lip G, et al. Chest 2010; 137: 263-272

  12. ESC Guidelines on AF Eur Heart J 2012; 33: 2719-47

  13. CHA2DS2Vasc score e indicazioni alla TAO nella FA non valvolare Linee Guida AIAC per la gestione della FA, 2013

  14. The CHA2DS2-VASc score identifies pts with AF and a CHADS2 score 1 who are unlikely to benefit from OAT Pts from the AVERROES and ACTIVE trials treated with ASA ± clopidogrel Coppens M, Eur Heart J 2013; 34: 170-6

  15. R-CHADS2 CHA2DS2Vasc+ 2 for GFR < 60 Piccini JP for ATRIA Investigators Circulation 2013; 127: 224-32

  16. Cardiac biomarkers and risk of stroke in AF Hijazi et al for ARISTOTLE Inv. JACC 2014: 63: 52-61

  17. Hijazi et al for ARISTOTLE Inv. JACC 2014: 63: 52-61

  18. Hijaziet al forARISTOTLEInv. JACC 2014: 63: 52-61 Continuous and strong relationship between NT-proBNP concentration and stroke, mortality and major bleeding. This prognostic information independent of and additive to the CHADS2 score and other biomarkers. Apixaban consistently reduced stroke, mortality and bleeding, regardless of NT-proBNP level. Wallentin, L. et al. EHJ ( 2012 ) 33

  19. Hijazi et al for RELY Inv. Circulation 2012: 125: 1605-16

  20. HAS-BLED • ipertensione: PAS >160 mm Hg • disfunzione renale: dialisi/ trapianto/ creatinina > 200 μmol/L • disfunzione epatica: cirrosi/ bilirubina aumentata (x 2) + transaminasi aumentate (x 3) Pisters et al, Chest 2010; march 18

  21. ACCP Guidelines, Chest 2012

  22. Risk of stroke, HF, AMI and GI bleeding in pts with AF Piccini JP, Duke University, Eur Heart J 2014, 35: 250-6

  23. Risk of stroke, HF, AMI and GI bleeding in pts with AF Puccini JP, Duke University, Eur Heart J 2014, 35: 250-6

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