Anticoagulation in Atrial Fibrillation

This Harvard Medical School Continuing Education video examines these key questions: Who is an appropriate candidate for anticoagulation in atrial fibrillation (AF)? How is the CHA2DS2-Vasc score used to determine anticoagulation? What are bleeding risks associated with anticoagulation in AF patients? Dr. William Hucker, MD, PhD, a cardiologist at Massachusetts General Hospital, identifies the prevention of stroke and systemic embolism as vital aspects of AF management and explains the use of the CHA2DS2-Vasc score to determine which patients should be anticoagulated. The use of DOACs in nonvalvular AF is discussed and addressing bleeding risk with patients is reviewed. 00:00 | Introduction 00:41 | Treatment of atrial fibrillation 01:29 | Risk stratification for AF 03:55 | Guidelines for anticoagulation 06:50 | Addressing bleeding risks 08:55 | Periprocedural anticoagulation considerations This video was peer reviewed by Dr. Jonathan Salik, TMD, MHPEd, Instructor of Medicine, Massachusetts General Hospital; and Dr. Sugantha Sundar, MD, Assistant Professor of Anesthesia, Beth Israel Deaconess Medical Center, to validate the quality and accuracy of the content. References: Friberg L, Skeppholm M, Terént A. Benefit of anticoagulation unlikely in patients with atrial fibrillation and a CHA2DS2-VASc score of 1. J Am Coll Cardiol. 2015;65(3):225-232. doi:10.1016/j.jacc.2014.10.052 Writing Group Members, January CT, Wann LS, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2019;16(8):e66-e93. doi:10.1016/j.hrthm.2019.01.024 Granger, CB, Patel MR, Mahaffey KW, Garg J, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011. Connolly SJ, Eikelboom J, Joyner C, Diener H, et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011;364:806-817. doi:10.1056/NEJMoa1007432 Douketis JD, Spyropoulos AM, Kaatz S, Becker RC, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015;373:823-833. doi:10.1056/NEJMoa1501035 Notice: At this time, the content in this video is not accredited.