John Catanzaro, MD, on Preventing Stroke in AFib
Recently, the American Heart Association, American College of Cardiology, and Heart Rhythm Society published updated guidelines on pharmacological management of atrial fibrillation (AFib).1 The guidelines now recommend non-vitamin K oral anticoagulants (NOACs) over warfarin for the prevention of stroke in patients with AFib.
In terms of nonpharmacological options, atrial appendage closure device is the now the standard of care, according to John Catanzaro, MD, FACC, who is an assistant professor in the Department of Medicine, Division of Cardiology, and associate medical director of the Electrophysiology Program at the University of Florida Jacksonville.
Dr Catanzaro recently spoke about nonpharmacologic options for preventing stroke in patients with AFib at the Women and Heart Disease Conference: New Therapies in CVD.2
“The atrial appendage closure device is indicated for patients with a CHADS score of at least 2, CHADS2-VASC score of greater than or equal to 3, shared decision-making tool using appropriate rationale, which may take into account fall risk, poor compliance, inability maintaining target international normalized ratio (INR) range, intolerance of warfarin or NOACs, increased bleeding by HAS-BLED score (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol), occupational hazards, or advanced renal failure,” Dr Catanzaro said.
While the CHADS-VASc score takes female gender into consideration, Dr Catanzaro says that additional risk factors for stroke must be considered in women when determining whether atrial appendage closure device is appropriate.
“These include Hormone replacement therapy, the postpartumstate, as well as peripheral artery disease. Clinical acumen must be used when deciding to opt for a left atrial appendage closure device.”
Other risk factors for stroke for men and women, such as weight, hypertension, hypercholesterolemia, and diabetes, may be modified with physical activity, although “some studies do not demonstrate a causal link between exercise and lower stroke risk,” Dr Catanzaro said.
According to the National Stroke Association, 800,000 people experience a new or recurrent stroke each year, and 80% of those strokes can be prevented. Therefore, it is important for health care providers and their patients to know their options: “Health care providers should know that nonpharmacologic options for stroke prevention in patients with AFib exist. The standard is nonpharmacologic therapy, and patients who have a reason to consider it should know there is a solution,” Dr Catanzaro said.
—Amanda Balbi
References:
- Murphy C. AHA updates guidelines for anticoagulants in AFib [published online January 28, 2019]. Cardiol Consultant. https://www.consultant360.com/exclusive/cardiology/arrhythmia-ep/aha-updates-guidelines-anticoagulants-afib.
- Catanzaro J, Levine J. Non-pharmacologic stroke prevention in atrial fibrillation. Session presented at: Women and Heart Disease Conference: New Therapies in CVD; February 2, 2019; Jacksonville, FL. https://com-cme-womens-heart.sites.medinfo.ufl.edu/files/2018/07/Agenda-7.6.pdf. Accessed February 5, 2019.