Activity 2: Thromboprophylaxis in Atrial Fibrillation: A Case-Based Approach to Management
Evidence-based guidelines for the prevention of thromboembolic events in patients with atrial fibrillation (AF) are available, but many situations are not addressed by these guidelines. For example, patients with multiple comorbidities, patients with a history of peptic ulcer disease, and patients at high risk of bleeding often fall into the “gray areas” of stroke prevention.
In this activity, Thromboprophylaxis in Atrial Fibrillation: A Case-Based Approach to Management, faculty give practical guidance on scenarios not directly addressed by guidelines and recommendations. Using patient cases, faculty reinforce principles of management addressed in the first activity in this series, Thromboprophylaxis in Atrial Fibrillation: Current Issues and Challenges. Cases focus on deciding between anticoagulation and antiplatelet agents for low-risk patients, balancing bleeding risk against stroke risk, and considering the therapeutic role of new anticoagulant agents.
This continuing medical education program is intended for family physicians and other primary care providers who manage patients with atrial fibrillation.
After completing this activity, family physicians will be better able to:
- Demonstrate increased awareness of the range of assessment tools and evidence-based guidelines available to aid thrombotic risk stratification in AF and incorporate this knowledge into practice.
- Describe the role of antithrombotic therapy in AF patients at risk of stroke and be aware of the implications of underprescribing.
- Describe the safety and efficacy profile of the currently available antithrombotic therapies, including issues surrounding patient selection.
- Describe the approach to dosing and therapeutic drug monitoring for antithrombotic therapy in AF patients at risk of stroke based on evidence-based guidelines, and incorporate this knowledge into the care of patients.
- Outline strategies for risk reduction in challenging patient populations and incorporate this knowledge into practice.
- Describe emerging antithrombotic therapies and other new developments on the prevention of stroke in AF, including issues surrounding patient selection and monitoring.
Neil Skolnik, MD
Professor of Family and Community Medicine
Temple University School of Medicine
Associate Director, Family Medicine Residency Program
Abington Memorial Hospital
Matthew Sorrentino, MD, FACC
Professor of Medicine
University of Chicago Pritzker School of Medicine
Section of Cardiology
This enduring material activity, Thromboprophylaxis in Atrial Fibrillation: A Case-Based Approach to Management, (the second activity in the Thromboprophylaxis in Atrial Fibrillation series), has been reviewed and is acceptable for up to 1 Prescribed credit(s) by the American Academy of Family Physicians. This activity conforms to the AAFP criteria for evidence-based CME clinical content. AAFP accreditation begins June 1, 2011. Term of approval is for 2 year(s) from this date with the option of yearly renewal.
The evidence-based CME content developed for this activity was based on practice recommendations that were the most current with the strongest level of evidence available at the time this activity was approved. Since some clinical research is ongoing, the American Academy of Family Physicians recommends that learners verify sources and review these and other recommendations prior to implementation into practice.
The AAFP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The American Academy of Family Physicians designates this enduring material for a maximum of 1 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Introduction and Opening Remarks
Module 1. Case 1: To Anticoagulate or Not To Anticoagulate?
Module 2. Case 2: Choice of Anticoagulant
Module 3. Case 3: The Impact of Patient Factors on Choice of Anticoagulant
Module 4. Case 4: Balancing Benefit and Risk
It is the policy of the AAFP that all CME planning committee/faculty/authors/editors/staff disclose relationships with commercial entities upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest and, if identified, they are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.
The AAFP and MedEd Architects, LLC staffs have indicated that they have no relationships to disclose relating to the subject matter of the activity. Dr. Sorrentino returned a disclosure form indicating that he has served on speakers’ bureaus for Pfizer, Merck and Takeda on the topic of hypercholesterolemia, and for Novartis on the topic of hypertension. Dr. Skolnik returned a disclosure form indicating that he has served as a consultant for AstraZeneca on the topics of asthma, COPD and cholesterol, for Merck on the topic of asthma, and for Purdue on the topic of pain management. He has also served on speakers’ bureaus for AstraZeneca on the topics of asthma and COPD, and for Merck on the topic of asthma.