Discrepant Atrial Fibrillation Guidelines

Authors

  • Antonis S Manolis Athens University School of Medicine & First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece

Keywords:

atrial fibrillation, guidelines, anticoagulation, rate control, rhythm control

Abstract

Recently, cardiological societies in Europe (ESC), US and Canada (CCS) have updated their guidelines for atrial fibrillation (AF). However, there are several discrepancies which have been identified and discussed. Among them, the following are the most blatant ones.

 • Anticoagulation. Atrial fibrillation confers a 5-fold increase in the risk of stroke if left without anticoagulation therapy and a 2-fold increase in the risk of death from such thromboembolic strokes. The US guidelines recommend anticoagulation for a patient with a CHADS2 score of ≥2, and either aspirin or anticoagulation for a patient with a CHADS2 score of 1, while the CCS and ESC guidelines recommend anticoagulation for a patient with ≥1 risk factor(s). The new anticoagulants are taken into consideration by the CCS guidelines, recommending dabigatran instead of vitamin K antagonists (VKA). The ESC guidelines make recommendations for future use of dabigatran (when approved in the EU) depending on the risk of bleeding; for low-risk patients it may be considered, while for higher risk patients the lower dose of 110 mg of dabigatran may be considered. Also patients with a CHADS2 score of 1 may receive the lower dose (110 mg) of dabigatran. The US guidelines issued an update for dabigatran, indicating that it is a useful alternative to VKA... (excerpt)

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Published

2011-04-01

Issue

Vol. 6 No. 2 (2011)

Section

Editorial

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