Thromboprophylaxis in Atrial Fibrillation
Atrial fibrillation (AF) is the most common arrhythmia that physicians encounter in clinical practice, and it accounts for about one-third of hospitalizations for arrhythmia.1 Compared with the general population, people with atrial fibrillation have a fivefold increase in the risk of stroke.2 Given the predicted increase in prevalence of AF over the next few years3, it is vital that family physicians are equipped to effectively prevent stroke in this patient population. However, although prevention of thromboembolism in patients with AF is a key issue for the health care community, studies show that underprescribing of anticoagulants persists.4
This two-part series, Thromboprophylaxis in Atrial Fibrillation, reviews and applies evidence-based guidelines for the prevention of stroke in patients with AF, and provides guidance on the role of new pharmacological agents. Downloadable resources offer easy access to evidence-based recommendations, useful references, practice tools and patient education materials.
- Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines. Circulation 2006;114: e257-354.
- Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991;22:983-8.
- Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, et al. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention. The AnTicoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study. JAMA 2001;285:2370-5.
- Lip GY, Watson T. Stroke prevention in atrial fibrillation -- things can only get better. Br J Clin Pharmacol 2007;64:575-7.
After completing the activities in this series, 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 practice.
- Outline strategies for risk reduction in challenging patient populations and incorporate this knowledge into practice.
- Describe emerging antithrombotic therapies and other new developments in the prevention of stroke in AF, including issues surrounding patient selection and monitoring.
Activity 1: Thromboprophylaxis in Atrial Fibrillation: Current Issues and Challenges
Activity 2: Thromboprophylaxis in Atrial Fibrillation: A Case-Based Approach to Management
Acknowledgement of Support
This activity is supported by an independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.