Discrepant Atrial Fibrillation Guidelines
Keywords:
atrial fibrillation, guidelines, anticoagulation, rate control, rhythm controlAbstract
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)
Downloads
Downloads
Published
Issue
Section
License
Authors who publish with this journal agree to the following terms:
a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
