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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com


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viernes, 27 de noviembre de 2015

Anticoagulación en FA reciente

November 27, 2015 - By Zach Adams // Edited by Michael Barrie
In patients with unknown duration of AF or duration >48 hours, initiation of anticoagulation for 3 weeks prior to elective cardioversion or a TEE based approach with post-cardioversion anticoagulation is warranted. Such patients presenting in the ED should be dispositioned depending on the decision of rate versus rhythm control as well as anticoagulation therapy in conjunction with cardiology and the patient.
In patients with new onset AF or duration <48 hours, the decision to cardiovert the patient (either chemically or electrically if they haven’t spontaneously converted) warrants careful assessment of risk factors and periprocedural and post-cardioversion anticoagulation depending on the overall risk. Consideration might be given to utilization of pre-cardioversion heparin or NOAC before cardioversion in moderate to high risk patients (CHAD2DS2-VASc ≧ 1) followed by long-term anticoagulation. For low risk patients (CHA2DS2-VASc = 0), recommendations are either for no anticoagulation or pre-procedural anticoagulation and 4 weeks of anticoagulation thereafter to further reduce the risk of stroke. Bleeding risk assessment can guide therapy using the HAS-BLED score."