Dr. Annabelle Volgman from the Rush University Medical Center, Chicago IL moderated the topic "New Anticoagulants vs Warfarin: Take Your Choice" with Drs. Peter Kowey from Main Line Health and Jefferson Medical College, Philadelphia, PA, James Reiffel from Columbia University Medical Center, New York, NY, and Albert Waldo from University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH.
The discussion focused primarily on:
- How to approach a patient with a Congestive heart failure, Hypertension, Age ≥75, Diabetes mellitus, Stroke (CHADS2) score of 1;
- the lack of efficacy of aspirin as an oral anticoagulant to prevent stroke in atrial fibrillation;
- recommendations of various recent guidelines concerning the use of aspirin;
- the use of aspirin and clopidogrel in comparison to new anticoagulants as an alternative to warfarin;
- clarification of the American College of Chest Physicians guidelines for 2012;
- stroke risk prediction with the Congestive heart failure, Hypertension, Age ≥75, Diabetes mellitus, Stroke, Vascular disease, Age 65–74 years, Sex category (CHA2DS2-VASc) score;
- balancing the risk of stroke against the risk of bleeding risk and falls;
- estimation of bleeding risk with Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) scores;
- choice of anticoagulant in different patients; and
- support for patients with active bleeding on dabigatran or rivaroxaban in comparison to warfarin.
(Med Roundtable Cardiovasc Ed. 2014;3(4):262–270).
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