What the 2023 AFib Guidelines Tell Us About Anti-Coagulation, Stroke Prevention, and Non-Pharmacological Therapies (On Demand)-Anti-Coagulation, Stroke Prevention, and Non-Pharmacological Therapies

Video Transcription

Video Summary

In a recent HRS-sponsored webinar, Dr. Mina Chung, along with esteemed colleagues, discussed the 2023 AFib Guidelines focusing on anticoagulation, stroke prevention, and non-pharmacological therapies. Dr. Fred Kusumoto from Mayo Clinic started by explaining the significant and increasing risk of stroke in patients with AFib. He emphasized the importance of using validated clinical risk scores, like CHADS-VASc, while acknowledging their limitations. Kusumoto highlighted additional risk factors such as uncontrolled hypertension, diabetes, and specific biomarkers like BNP and GDF-15 that might better identify stroke risk compared to traditional scores.<br /><br />Dr. Nimesh Patel from UT Southwestern covered certain special populations and non-pharmacologic therapies. He discussed recommendations for anticoagulation in patients with AFib undergoing PCI or dealing with chronic kidney disease. Patel then reviewed evidence supporting percutaneous and surgical left atrial appendage closure for stroke prevention, noting both procedures' pros and cons.<br /><br />Both experts also addressed post-operative AFib and the nuanced decision-making required for anticoagulation in this context. Patel shared insights from the LAOS III trial, noting the benefit of surgical occlusion in reducing systemic embolism but stressing the continued need for anticoagulation in these patients. <br /><br />During the discussion, the panelists debated the emerging role of left atrial appendage closure devices, particularly Watchman, often driven by patient preference and cost considerations. They also touched on challenges like residual stroke risk despite anticoagulation and the potential benefits of next-generation anticoagulants and genetic testing.<br /><br />Overall, the webinar provided a thorough exploration of contemporary strategies for managing AFib to reduce stroke risk, urging personalized and evidence-based approaches guided by ongoing research and patient preferences.

Keywords

AFib Guidelines

anticoagulation

stroke prevention

non-pharmacological therapies

CHADS-VASc

left atrial appendage closure

PCI

chronic kidney disease

LAOS III trial

Watchman device

genetic testing