Stroke Prevention in Atrial Fibrillation

Figures

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  Figure 1. Flowchart of Management of Patients With Chronic Liver Disease∗ The Child-Pugh scoring system is used to guide the management of patients with chronic liver disease. ∗Rivaroxaban should not be used in patients with Child-Pugh B. INR = international normalized ratio; NOAC = non-vitamin K antagonist oral anticoagulant; PT = prothrombin time.

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  Figure 2. Simple Standardized Periprocedural Strategy for NOAC Use The interruption and resumption strategy for DOACs is based on the pharmacokinetic properties of NOACs, procedure-associated bleeding risk, and creatinine clearance (CrCl) levels. Refer to Table 8 to determine levels of periprocedural bleeding risk. CrCl = creatinine clearance; NOAC = non-vitamin K antagonist oral anticoagulant.

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  Figure 3. Management Strategy for Bleeding Events While Receiving NOAC Treatment When dealing with bleeding events, patients’ histories should be thoroughly checked, including types and doses of NOACs and other modifiable risk factors for bleeding, such as suboptimally treated hypertension, excess alcohol intake, concomitant antiplatelet therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and others. Furthermore, regular interdisciplinary review and shared decision making are needed. ∗Defined by International Society on Thrombosis and Hemostasis (ISTH). aPCC = activated prothrombin complex concentrate; FXa = factor Xa; LAAO = left atrial appendage occlusion; NOAC = non-vitamin K antagonist oral anticoagulant; NSAID = non-steroidal anti-inflammatory drug; PCC = prothrombin complex concentrate.

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  Central Illustration. Choice of Anticoagulant Agents According to Patient Characteristics Most of the recommendations were based on randomized controlled trials or their subgroup analyses and international guidelines. A few of them were based on data from real-world evidence (RWE) or indirect evidence. Modified with permission from Lip et al.92 ∗Type 2 valvular heart diseases were defined previously by a European consensus,93 including all valvular heart diseases but excluding mechanical valves and moderate to severe mitral stenosis. A = apixaban; AF = atrial fibrillation; CKD = chronic kidney disease; CrCl = creatinine clearance; D = dabigatran; E = edoxaban; NOAC = non-vitamin K antagonist oral anticoagulant; OAC = oral anticoagulant agent; R = rivaroxaban; RCT = randomized controlled trial; Ref = reference; TIA = transient ischemic attack; VKA = vitamin K antagonist.