The document outlines guidelines for anticoagulation in atrial fibrillation, emphasizing the need for practitioners to base their prescriptions on personal experience and updated scientific evidence. It discusses factors like patient history, bleeding risks, and various anticoagulant options including warfarin and NOACs. The content is part of a lecture series delivered by Dr. Raja Mohammed at Sheikh Jaber Al Ahmed Hospital in 2019.

1. ATRIAL FIBRILLATION – LECTURE SERIES
GUIDELINES ON
ANTICOAGULATION IN
ATRIAL FIBRILLATION
Dr RAJA MOHAMMED, MD, MESC
Specialist in Cardiology,
Sheikh Jaber Al Ahmed Hospital, Ministry of Health,
KUWAIT

2. FOREWORD
Medical science is an ever changing science. Practitioners must always rely on their
own experience and latest scientific evidence before prescribing. Sincere thanks to
European Society of Cardiology for the contents related to guidelines. Though the
content is taken from authenticated source and standard books the typing error and
content misquotes if any are solely mine.

3. ESC LEVELS OF EVIDENCE

4. ESC CLASS OF RECOMMENDATION

6. TIMELINE AND FINDINGS OF LANDMARK TRIALS

16. D Prior Alcohol or Drug Usage History ( ≥ 8 drinks / week) 1 also
Medication usage Predisposing to Bleeding (Antiplatelet agents, NSAID) 1
E Elderly: Age > 65 years 1
L Labile INR: (Unstable/ high INR),Time in therapeutic range < 60 % 1
B Bleeding: Prior major bleeding / predisposition to bleeding 1
S Stroke : Prior history of stroke 1
A Abnormal renal function: Dialysis, transplant, Cr > 2.26 mg/ dL or 200 µmol/L 1 also
Abnormal liver function : Cirrhosis or Bilirubin > 2 × Normal or AST/ ALT/ AP > 3 × Normal 1
H Hypertension(uncontrolled, >160 mmHg systolic ) 1
HAS BLED risk score – condition & points to assess 1 year risk of major bleeding

32. 1. Male patient, 65 year old, had undergone Mitral
valve replacement 15 years ago, admitted with
episodes of blackout, after initial imaging studies
to rule out bleeding, he is to be resumed on Oral
anti coagulants
Choice of drug will be
1. Vitamin K Antagonist , Warfarin
2. NOAC- Dabigatran
3. Aspirin
4. Aspirin with clopidogrel
Recap of the contents

33. 2. Female patient aged 62 years sedentary lifestyle,
hypertensive, known case of atrial fibrillation,
presented with ACS, underwent PCI, the three drug
regimen of dual antiplatelets and NOAC to be
considered for
1. 1 year
2. Lifelong
3. 1 to 6 months
4. None of the above

34. Thank you.. Have a great
day..
This lecture is given by me as part of series of lectures at Sheikh Jaber Al Ahmed hospital, during 2019