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Task Force Members, Gregory Y.H. Lip, Stephan Windecker, Kurt Huber, Paulus Kirchhof, Francisco Marin, Jurriën M. Ten Berg, Karl Georg Haeusler, Giuseppe Boriani, Davide Capodanno, Martine Gilard, Uwe Zeymer, Deirdre Lane, Document Reviewers, Robert F. Storey, Hector Bueno, Jean-Philippe Collet, Laurent Fauchier, Sigrun Halvorsen, Maddalena Lettino, Joao Morais, Christian Mueller, Tatjana S. Potpara, Lars Hvilsted Rasmussen, Andrea Rubboli, Juan Tamargo, Marco Valgimigli, Jose L. Zamorano, Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS), European Heart Journal, Volume 35, Issue 45, 1 December 2014, Pages 3155–3179, https://doi.org/10.1093/eurheartj/ehu298
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Introduction
Atrial fibrillation (AF) confers a substantial risk of mortality and morbidity from stroke and thrombo-embolism, and this common cardiac arrhythmia represents a major healthcare burden in Europe.1 Stroke prevention is central to the management of AF patients, with the 2012 focused update of the European Society of Cardiology (ESC) guidelines2 recommending oral anticoagulation (OAC) using well-controlled adjusted dose vitamin K antagonists (VKAs, e.g. warfarin) or non-VKA oral anticoagulants (NOACs, previously referred to as new or novel OACs3) for patients with AF and ≥1 stroke risk factor(s). Also, these guidelines strongly advocate a clinical practice shift so that the initial decision step now is the identification of ‘truly low risk’ patients, essentially those aged <65 years without any stroke risk factor (both male and female), who do not need any antithrombotic therapy.2 The ESC guidelines also recommend the use of the CHA2DS2-VASc score4 for stroke risk assessment, and define ‘low-risk’ patients as those with a CHA2DS2-VASc score = 0 (males) or score = 1 (females). Subsequent to this initial step of identifying the low-risk patients, effective stroke prevention (which is essentially OAC) can then be offered to AF patients with ≥1 stroke risk factor(s), with treatment decisions made in consultation with patients and incorporating their preferences.
- acute coronary syndromes
- antiplatelet agents
- aspirin
- atrial fibrillation
- clopidogrel
- fibrinolytic agents
- stents
- thrombosis
- hemorrhage
- asia
- cardiac care facilities
- cardiovascular system
- embolism
- vitamin k antagonists
- cardiac rhythm
- consensus
- risk of excessive or recurrent bleeding
- european society of cardiology
- direct oral anticoagulants