Quick Pocket Guide to New Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation - Daniel A. Godoy - ebook
Opis

Cardioembolic strokes account for one third of ischemic strokes and atrial fibrillation (AF) representing the main source of this stroke subtype. The rate of stroke is 5%/year in patients with AF. Patients with AF have a 2-7 fold increased risk of stroke compared to patients without. Stroke prevention in atrial fibrillation (SPAF) is therefore of utmost importance and represents a major point in the modern management of AF. This booklet provides an overview of new oral anticoagulants used, listing their pharmacokinetis profile, the evidence of efficacy and their clinical use.

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Quick Pocket Guide to New Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation

© SEEd srl

Piazza Carlo Emanuele II, 19 – 10123 Torino – Italy Tel. +39.011.566.02.58 – Fax [email protected]

Luca Masotti. Internal Medicine, Cecina Hospital, Italy

Mario Di Napoli. Neurological Service, San Camillo de’ Lellis General Hospital, Rieti, Italy

Daniel A. Godoy. Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, Argentina

Roberto Cappelli. Thombosis Center, Siena University, Italy

First edition April 2012 ISBN 978-88-9741-930-3

Although the information about medication given in this book has been carefully checked, the author and publisher accept no liability for the accuracy of this information. In every individual case the user must check such information by consulting the relevant literature.

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the Italian Copyright Law in its current version, and permission for use must always be obtained from SEEd Medical Publishers Srl. Violations are liable to prosecution under the Italian Copyright Law.

Introduction

Cardioembolic strokes account for one third of ischemic strokes and atrial fibrillation (AF) representing the main source of this stroke subtype [1].

The rate of stroke is 5%/year in patients with AF. Patients with AF have a 2-7 fold increased risk of stroke compared to patients without [1-4]. Cardioembolic strokes have poorer prognosis compared to other subtypes of ischemic strokes, such as atherotrombotic and lacunar subtypes, due to wider ischemic damage and major risk of hemorrhagic transformation with the consequence of higher risk of in-hospital, 30-day and 12-month mortality and severe disability [5-7].

Stroke prevention in atrial fibrillation (SPAF) is therefore of utmost importance and represents a major point in the modern management of AF [2-4].

SPAF is based on antithrombotic treatment. An ideal antithrombotic drug would have the following characteristics:

orally administrable;

wide therapeutic window;

fixed dose with predictable pharmacologic profile;

few drug/food interactions obviating the need for closer monitoring.

Risk factors

The risk of stroke is high in patients with AF associated to severe mitral stenosis, mechanical prosthetic valve, history of previous cerebrovascular ischemic event; moderate when AF is associated to age over than 75 years, systemic blood hypertension, diabetes mellitus, heart failure with depressed contractility; finally is low but consistent when AF is associated to female sex, vascular disease such as coronary artery disease or peripheral artery disease, age 65 to 74 years and thyrotoxicosis [2-4,8].

Score

Risk factor

Points

C – Congestive heart failure

1

H – Hypertension

1

A – Age>75 years

1

D – Diabetes

1

S2 – Prior stroke/TIA

2

Results: annual rate of stroke and systemic embolism

Points

Rate

0

1.9%

1

2.8%

2

4.0%

3

5.9%

4

8.5%

5

12.5%

6

18.2%

Table I. CHADS2 score

Score

Risk factor

Points

C – Congestive heart failure

1

H – Hypertension

1

A2 – Age>75 years

2

D – Diabetes

1

S2 – Prior stroke/TIA

2

V – Vascular diseases

1

A – Age 65-74

1

SC – Sex category (females)

1

Results: annual rate of stroke and systemic embolism

Points