Atrial Fibrillation

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new updates about AF
In the AMADEUS trial(4576 patients), Idraparinux was non inferior to warfarin but more risk of bleeding 19 % vs. 11%

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Atrial Fibrillation

  1. 1. Atrial Fibrillation New update June 2009 Dr Ihab Suliman MBBS,ECFMG(USA),MRCP(UK), DCBNC(USA)
  2. 2. Outline • Introduction • Importance • Demographics • Rate or Rhythm • Anticoagulation • Conclusion
  3. 3. AF • Is the the most common sustained arrhythmia. • Above the age of 40, the life time risk of developing AF is 25%.
  4. 4. Demographics • 3 millions cases of AF in USA, 4.5 millions in Europe. • 83% of AF patients are above 65 years of age.
  5. 5. Associated Co-morbid issues with AF • Hypertension 37%. • CHF 23%. • CAD 18%. • Diabetes Mellitus 15%.
  6. 6. Importance • Patients with AF even on optimum medical therapy, have higher mortality than those with Normal Sinus . • Risk of stroke in non-valvular AF is 5 times than those without, in case of valvular AF riskis even much higher 18-23 times.
  7. 7. AF & Stroke • AF is responsible for 15 % of all strokes. • AF is the most important cause of stroke in women above the age of 75 years.
  8. 8. AF & risk of stroke (CHADS2) Risk of stroke(up to 20 fold) varies depending on the clinical picture Score(points) Prevalence(%) Prior stroke or TIA 2 10 Age > 75 years 1 28 Hypertension 1 65 Diabetes Mellitus 1 18 Heart Failure 1 32
  9. 9. CHADS score , risk of stroke Score ( points) Stroke Rate % per year VKAs vs. no VKAs crude ratio( 95% relative risk) 0 0.5-2.2 0.50 (0.20-1.28) 1 2.0-4.5 0.47(0.30-0.73) 2 0.51(0.35-0.75) 3 0.42(0.28-0.62) 4 6-12 0.30(0.20-0.75) 5 0.67(0.28-1.60)
  10. 10. Rate or Rhythm • AFFIRM trial showed no mortality difference. • AF-CHF , showed even in heart failure, no difference in mortality between the two strategies.
  11. 11. Anticoagulation • VKAs • Antiplatelets. • Thrombin inhibitor • Factor Xa Inhibitor
  12. 12. Ximelagatran (Exanta) First ever oral thrombin inhibitor • Now out of clinical use due to liver toxicity 10%. • Studied in Phase III trials like SPORTIF III(3407 patients ) SPORTIF V (3922 patients) vs. warfarin. • Rate of stroke was similar 1.6 % per annum, marginally less bleeding with Ximelagatran
  13. 13. Idraparinux Long acting Xa Inhibitor (once a WK) • In the AMADEUS trial(4576 patients), Idraparinux was non inferior to warfarin but more risk of bleeding 19 % vs. 11%

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