CHEST Guidelines-Antithrombotic Therapy for Atrial Fibrillation

Antithrombotic Therapy for Atrial Fibrillation

Pdf Summary

The 2018 CHEST Guideline on Antithrombotic Therapy for Atrial Fibrillation (AF) outlines recommendations for managing stroke risk in AF patients using antithrombotic treatment. Key recommendations are centered around evaluating stroke risk with the CHA2DS2-VASc score to identify patients at low risk who do not require antithrombotic treatment. For patients with more than one risk factor, anticoagulation therapy is advised, preferably using non-vitamin K antagonist oral anticoagulants (NOACs) over vitamin K antagonists (VKAs), unless ineligible due to valvular heart disease or other contraindications.<br /><br />The document distinguishes between patients with non-valvular and valvular AF. For people with valvular AF, especially those with mechanical heart valves or significant mitral stenosis, VKAs remain the standard treatment due to their proven efficacy and the lack of supporting data for NOACs in this subgroup.<br /><br />Bleeding risk assessment is crucial, and the guideline recommends the HAS-BLED score to identify patients who are at higher risk of bleeding. The score helps healthcare providers adopt measures to minimize bleeding risk via patient education, regular monitoring, and addressing any modifiable risk factors such as blood pressure management and avoiding concurrent use of certain medications like NSAIDs.<br /><br />Periprocedural anticoagulation management is discussed, emphasizing uninterrupted anticoagulation during procedures like cardioversion and catheter ablation to reduce thromboembolic risks. The guideline also covers managing bleeding on anticoagulation and suggests specific reversal agents for NOACs.<br /><br />For special populations, such as patients with chronic kidney disease (CKD), pregnant women, and those with acute or recovered stroke, individualized treatment plans are advised considering drug pharmacokinetics and the risk-benefit profile of OAC.<br /><br />For patients with atrial flutter or those detected with atrial high-rate episodes via implantable devices, similar risk-based strategies apply, reflecting on each patient's stroke and bleeding risks. This comprehensive guideline is endorsed by several prominent health societies and aims to facilitate informed, evidence-based antithrombotic therapy decisions for practitioners managing individuals with AF.

Keywords

CHEST Guideline

Antithrombotic Therapy

Atrial Fibrillation

Stroke Risk

CHA2DS2-VASc

Non-vitamin K antagonist oral anticoagulants

Valvular Heart Disease

HAS-BLED score

Periprocedural Anticoagulation

Chronic Kidney Disease