Document Detail


Antithrombotic therapy in atrial fibrillation: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
MedLine Citation:
PMID:  15383480     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This chapter about antithrombotic therapy in atrial fibrillation (AF) is part of the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence Based Guidelines. Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patients' values may lead to different choices (for a full understanding of the grading see Guyatt et al, CHEST 2004; 126:179S-187S). Among the key recommendations in this chapter are the following (all vitamin K antagonist [VKA] recommendations have a target international normalized ratio [INR] of 2.5; range, 2.0 to 3.0): In patients with persistent or paroxysmal AF (PAF) [intermittent AF] at high risk of stroke (ie, having any of the following features: prior ischemic stroke, transient ischemic attack, or systemic embolism, age > 75 years, moderately or severely impaired left ventricular systolic function and/or congestive heart failure, history of hypertension, or diabetes mellitus), we recommend anticoagulation with an oral VKA, such as warfarin (Grade 1A). In patients with persistent AF or PAF, age 65 to 75 years, in the absence of other risk factors, we recommend antithrombotic therapy with either an oral VKA or aspirin, 325 mg/d, in this group of patients who are at intermediate risk of stroke (Grade 1A). In patients with persistent AF or PAF < 65 years old and with no other risk factors, we recommend aspirin, 325 mg/d (Grade 1B). For patients with AF and mitral stenosis, we recommend anticoagulation with an oral VKA (Grade 1C+). For patients with AF and prosthetic heart valves, we recommend anticoagulation with an oral VKA (Grade 1C+); the target INR may be increased and aspirin added depending on valve type and position, and on patient factors. For patients with AF of > or = 48 h or of unknown duration for whom pharmacologic or electrical cardioversion is planned, we recommend anticoagulation with an oral VKA for 3 weeks before and for at least 4 weeks after successful cardioversion (Grade 1C+). For patients with AF of > or = 48 h or of unknown duration undergoing pharmacologic or electrical cardioversion, an alternative strategy is anticoagulation and screening multiplane transesophageal echocardiography (Grade 1B). If no thrombus is seen and cardioversion is successful, we recommend anticoagulation for at least 4 weeks (Grade 1B). For patients with AF of known duration < 48 h, we suggest cardioversion without anticoagulation (Grade 2C). However, in patients without contraindications to anticoagulation, we suggest beginning IV heparin or low molecular weight heparin at presentation (Grade 2C).
Authors:
Daniel E Singer; Gregory W Albers; James E Dalen; Alan S Go; Jonathan L Halperin; Warren J Manning
Publication Detail:
Type:  Guideline; Journal Article; Practice Guideline; Review    
Journal Detail:
Title:  Chest     Volume:  126     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-09-22     Completed Date:  2004-10-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  429S-456S     Citation Subset:  AIM; IM    
Affiliation:
Clinical Epidemiology Unit, S50-9, Massachusetts General Hospital, Boston, MA 02114, USA. dsinger@partners.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Atrial Fibrillation / blood,  complications,  drug therapy*
Atrial Flutter / blood,  complications,  drug therapy
Electric Countershock
Evidence-Based Medicine
Fibrinolytic Agents / adverse effects,  therapeutic use*
Heparin / adverse effects,  therapeutic use
Heparin, Low-Molecular-Weight / adverse effects,  therapeutic use
Humans
International Normalized Ratio
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Stroke / blood,  prevention & control*
Vitamin K / antagonists & inhibitors
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Heparin, Low-Molecular-Weight; 12001-79-5/Vitamin K; 9005-49-6/Heparin
Comments/Corrections
Comment In:
Chest. 2005 Jul;128(1):475; author reply 475   [PMID:  16002984 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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