This article is more than 5 years old. Information may no longer be current.
Consider risk factors when choosing anti-clotting therapy
Expert panel says catheter ablation is a reasonable alternative to drug therapy in some patients.
Click Here to Manage Email Alerts
Risk factors for stroke are important in deciding the proper anti-clotting therapy for patients with atrial fibrillation, according to the latest guidelines for the management of patients with atrial fibrillation.
The revised guidelines, an update on 2001 recommendations, suggest that catheter ablation may be used if patients have little or no left atrial enlargement.
The ACC, the AHA and the European Society of Cardiology released the guidelines, available in Circulation.
The panel’s recommendations
The committee focused on stroke risk because AF is associated with long-term risk. As much as 15% to 20% of strokes occur in patients with AF, according to Valentin Fuster, MD, PhD, cochair of the guidelines writing committee and a professor of medicine at Mount Sinai Cardiovascular Institute in New York.
These strokes tend to be large and disabling. More than 2 million Americans have AF, as well as more than 4.5 million Europeans.
The panel designed the guidelines to help physicians prioritize patient care based on three steps, if possible: controlling heart rate, preventing clots and correcting rhythm disturbance.
The revised guidelines recommend daily aspirin therapy (81 mg to 325 mg) in patients with AF who have no stroke risk factors. Patients with one moderate risk factor, which includes age older than 75, high BP, HF, diabetes or impaired left ventricular systolic function, should take aspirin or warfarin.
Patients with more than one moderate risk factor or with any high risk factors — including previous stroke, transient ischemic attack, prosthetic heart valve or systematic embolism — should take warfarin, according to the recommendations.
The panel suggested that catheter ablation may also be used for patients who did not respond to drug therapy to stop rhythm disturbance.
Rhythm control may be preferred in patients younger than 70, especially if they have recurrent AF and no evidence of heart disease. The guidelines recommend starting with drugs and catheter ablation if the medication fails to prevent the attacks. Anti-clotting treatment, however, should still be based on stroke risk, rather than whether the patient maintains proper heart rhythm.
AF is a bigger issue as the population ages, according to Samuel Wann, MD, a writing committee member and section editor of the Health Policy, Patient and Practice Issues section of Cardiology Today. Therapies are evolving and as they do, the guidelines will require constant updating.
“It is important for general physicians, general cardiologists and electrophysiologists to keep abreast of the state of the art in caring for these patients,” Wann said. – by Lauren Riley
For more information:
- Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation – executive summary. Circulation. 2006;114:700-752.