-TFTs: should be done during initial discovery/change in condition (e.g. difficult to control rate)
-Electrolytes with Magnesium
-BUN/Creatinine (helpful when trying to decide if AAD or OAC)
-Echocardiogram: valvular disease or reduced LVEF
-Ambulatory monitoring: Holter
Stoke Risk in A. Fib - Answers Thromboembolism: primary morbidity assoc. w/ A.Fib. Thrombus
formation and dislodgement from left atrial appendage (LAA)
-Based on clinical risk factors and NOT on freq/duration of A.Fib
-Non-valvular meaning A. Fib presumably not r/t mitral valve heart disease, specifically mitral stenosis
-In general ~48hrs for clot formation; if duration known to be <48hrs, can cardiovert w/o AC
-Second option: transesophageal echo to confirm absence of LAA thrombus
-Risk of thrombus is increased in first 3-4 weeks after DCCV, when gradual return of atrial mechanical
function can result in high risk for thrombus
CHADS 2 - Answers CHF (1)
HTN (1)
Age >75 (1)
DM (1)
, Prior Stroke (2)
CHADS 2 VASc 2 - Answers CHF (1)
HTN (1)
Age >75 (2)
DM (1)
Prior Stroke (2)
Vascular disease (1)
Age 65-74 (1)
Female (1)
If score >2, oral anticoagulants (or if non valvular A. Fib for prior stoke, TIA)
If pt has nonvalvular A. Fib and CHADS2VASc2 score of 0, reasonable to omit anticoag therapy
New Anticoagulants - Answers -3 currently approved
-Tested against coumadin
-No sign. diff b/w the three of them except for S/Es
-Avoid potent Pgp inducers (rifampin, carbemazepine, phehytoin, phenobarb, St. John's wort) as will
decrease effect
-Riva and Apixa: Avoid potent inhibitors of CYP3A4 and Pgp (Azoles, Protease inhibitors, mycins), as will
INCREASE AC effect
Eliquis (apixaban) - Answers Dose: 5mg BID
Renal adjustment: 2.5mg twice daily, must have 2 or more of the following: Age >80yo, Body wt </=
60kg, Serum creatinine >/= 1.5mg/dL
Half life: 12 hours
Time to Peak: 3-4hours
Direct factor Xa inhibitor
Xarelto (rivaroxaban) - Answers Dose: 20mg daily w/evening meal of at least 500 calories for absorption
Renal Adjustment: CrCl 15-50mg once daily w/evening meal; CrCl <15mL/min: avoid use
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