Atrial fibrillation (AF) management has been transformed within the last decade by revised clinical guidance and availability of new drugs. Aspirin monotherapy, once accounting for almost half of all antithrombotic prescriptions for AF, is now an obsolete therapy. Anticoagulation is the treatment of choice for AF and direct oral anticoagulants (DOACs) have overtaken warfarin as the drug of first choice for new starters. However, management of one in four people with AF remains suboptimal, and this article reviews the major issues around antithrombotic and other treatments for AF.
This month’s Back to Basics summarizes the main features of the key direct oral anticoagulants (DOACs or NOACS). These drugs are becoming a standard therapy in many settings including stroke prevention, management of deep vein thrombosis and pulmonary embolism, and prevention of venous thromboembolism following hip and knee replacement.
Atrial fibrillation (AF) is the commonest sustained cardiac dysrhythmia, but is asymptomatic in about one quarter of patients. Case finding with subsequent assessment of the risk of stroke and bleeding are essential to ensure that the right patients receive appropriate intervention with oral anticoagulation.
The prevalence of atrial fibrillation (AF), together with the condition’s associated stroke and systemic thromboembolic risk, is increasing significantly. Fortunately, there are clear, evidence-based clinical guidelines and risk stratification tools, to ensure that patients can make informed choices about optimising their treatment and care.
Stroke related to atrial fibrillation can be prevented effectively through the use of anticoagulants. This article reviews recent guidelines, clinical trials and real-world evidence with non-vitamin K antagonist oral anticoagulants (NOACs) in patients with AF and provides practical guidance on the use of these newer agents in primary care.
Recent guidelines recommend two key steps to reduce ischaemic stroke in people with atrial fibrillation: 1. Improving the assessment of stroke risk and 2. Increasing the use of evidence-based anticoagulant therapy. In this article, leading specialists explain how to apply current guidelines to improve current practice in stroke prevention.
Venous thromboembolism (VTE) occurs when a blood clot forms in the wrong place, and it can cause serious illness or death. Treatment of VTE is currently very labour-intensive for nurses and awkward for patients. Novel treatments are more expensive and have their own risks. But this new approach is less reliant on nurse time and more straightforward for patients, and seems likely to become the norm during the next few years.
In-house D-dimer testing and the Wells Score combined meant that cases were referred to secondary care only when patients were strongly suspected to have VTE or pulmonary embolism. Some 86% of VTE cases had properly documented risk assessment.
Clots are life-saving in the right place at the right time, when they can stop us bleeding to death. But a clot in the wrong place can spell disaster, leading to heart attack, stroke, deep vein thrombosis or pulmonary embolism. This article explains why life-threatening clots can develop so quickly, what can be done to prevent them, and how each type of clot is treated.
Are they all the same? What are the risks?
Dr Frances Akinwunmi
Consultant Pharmacist (Anticoagulation), Imperial College Healthcare NHS Trust
Professor David Fitzmaurice
Professor of Primary Care, University of Birmingham
Dr Matthew Fay
GP and National Clinical Lead for Atrial Fibrillation, Westcliffe Medical Centre, Shipley
Dr Patrick Kesteven
Consultant Haematologist, Freeman Hospital, Newcastle-upon-Tyne