Atrial Fibrillation
Decision Aide (continued)
Risks of Anti-thrombotic Therapy
The risk reduction for stroke must be weighed against the risk of both minor and major bleeding episodes caused by aspirin, Warfarin or Dabigatran. The decision to take Warfarin must factor in the need for and inconvenience of frequent INR monitoring.
Structural Heart Disease
Patients with atrial fibrillation and structural heart disease:
hypertensive heart disease, coronary heart disease with LV dysfunction, rheumatic, valvular heart disease, congenital valvular heart disease (bicuspid aortic valve with aortic stenosis, mitral valve prolapse), hypertrophic cardiomyopathy (obstructive or nonobstructive), idiopathic dilated cardiomyopathy or complex congenital heart disease are at high risk for stroke and should
be on some form of oral anticoagulation. NB: Dabigatran is not indicated for valvular atrial fibrillation.
Use of this decision aide is intended to help the physician explain the risks and benefits of antiplatelet therapy and oral anticoagulation therapy to patients with atrial fibrillation. After review of the risks and benefits the patient is asked to make a facilitated decision on whether they wish to take oral anticoagulation therapy and whether they would prefer Warfarin with required INR monitoring or Dabigatran with more frequent dosing but no need for periodic INR monitoring.
It should then be determined who will initiate and monitor anticoagulation therapy. Communication between family physician and specialist is essential to ensure appropriate monitoring and/or consider referral to an anticoagulation clinic.
For a full list of references related to this Decision Aide and Guideline Summary, please click here.
|
