uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
A tailored treatment strategy: a modern approach for stroke prevention in patients with atrial fibrillation
Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England.;Aalborg Univ, Aalborg Thrombosis Res Unit, Dept Clin Med, Aalborg, Denmark..
Univ Belgrade, Cardiol Clin, Clin Ctr Serbia, Sch Med, Belgrade, Serbia..
Univ Bologna, S Orsola Malpighi Univ Hosp, Inst Cardiol, Dept Expt Diagnost & Specialty Med, Bologna, Italy..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
2016 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 279, no 5, 467-476 p.Article, review/survey (Refereed) PublishedText
Abstract [en]

The main priority in atrial fibrillation (AF) management is stroke prevention, following which decisions about rate or rhythm control are focused on the patient, being primarily for management of symptoms. Given that AF is commonly associated with various comorbidities, risk factors such as hypertension, heart failure, diabetes mellitus and sleep apnoea should be actively looked for and managed in a holistic approach to AF management. The objective of this review is to provide an overview of modern AF stroke prevention with a focus on tailored treatment strategies. Biomarkers and genetic factors have been proposed to help identify high-risk' patients to be targeted for oral anticoagulation, but ultimately their use must be balanced against that of more simple and practical considerations for everyday use. Current guidelines have directed focus on initial identification of truly low-risk' patients with AF, that is those patients with a CHA(2)DS(2)-VASc [congestive heart failure, hypertension, age 75years (two points), diabetes mellitus, stroke (two points), vascular disease, age 65-74years, sex category] score of 0 (male) or 1 (female), who do not need any antithrombotic therapy. Subsequently, patients with 1 stroke risk factors can be offered effective stroke prevention, that is oral anticoagulation. The SAMe-TT2R2 [sex female, age <60years, medical history (>2 comorbidities), treatment (interacting drugs), tobacco use (two points), race non-Caucasian (two points)] score can help physicians make informed decisions on those patients likely to do well on warfarin (SAMe-TT2R2 score 0-2) or those who are likely to have a poor time in therapeutic range (SAMe-TT2R2 score >2). A clinically focused tailored approach to assessment and stroke prevention in AF with the use of the CHA(2)DS(2)VASc, HAS-BLED [hypertension, abnormal renal/liver function (one or two points), stroke, bleeding history or predisposition, labile international normalized ratio, elderly (>65years) drugs/alcohol concomitantly (one or two points)] and SAMeTT(2)R(2) scores to evaluate stroke risk, bleeding risk and likelihood of successful warfarin therapy, respectively, is discussed.

Place, publisher, year, edition, pages
2016. Vol. 279, no 5, 467-476 p.
Keyword [en]
atrial fibrillation, bleeding, stroke
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-299183DOI: 10.1111/joim.12468ISI: 000374694000007OAI: oai:DiVA.org:uu-299183DiVA: diva2:949052
Available from: 2016-07-15 Created: 2016-07-15 Last updated: 2016-07-15Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Blomström-Lundqvist, Carina
By organisation
Cardiology-Arrhythmia
In the same journal
Journal of Internal Medicine
Cardiac and Cardiovascular Systems

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 26 hits
ReferencesLink to record
Permanent link

Direct link