The optimal antithrombotic regimen in patients with AF and comorbid CAD remains unclear. Current American College of Cardiology/American Heart Association guidelines provide minimal guidance on whether to continue antiplatelet therapy in combination with anticoagulation in this population. Additionally, while the 2017 European Society of Cardiology guidelines recommend oral anticoagulation alone, there is little supporting evidence for this recommendation. This blog discusses the implications of the recently published AFIRE study, which attempts to answer the question: In patients with stable CAD and AF, is combination therapy necessary or is anticoagulation monotherapy sufficient?
Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) often occur concomitantly. Despite this, optimal treatment strategies remain unclear. Current rate and rhythm control pharmacotherapy options present challenges when used in patients with HFrEF. In this blog, we cover 3 clinical pearls to consider for acute management of AF in patients with HFrEF.
The highly anticipated focused update of the 2014 atrial fibrillation guideline incorporates modified recommendations based on evidence from several recent publications. This blog will detail the four most important updates from the guideline, including a brief discussion of the data influencing these changes.
Have you ever wondered where the magic “10 gram” number comes from when determining a loading dose of amiodarone? In this blog we will review the data surrounding amiodarone loading in patients with atrial fibrillation and hemodynamically stable ventricular arrhythmias.
Although guidelines for the management of atrial fibrillation advocate for anticoagulation in patients with a high stroke risk (CHA2DS2-VASc score of 2 or greater), the recommendations for patients at low (CHA2DS2-VASc 0) and in particular intermediate (CHA2DS2-VASc 1) risk of stroke are less clear. In this blog, we discuss antithrombotic strategies in these latter two subgroups.
For patients with atrial fibrillation and structural heart disease, antiarrhythmic options remain limited. Although amiodarone has been a cornerstone of drug therapy in this population, dofetilide is a viable option for many patients. In this piece, we review the safety and efficacy of this often-overlooked drug.
Anticoagulants are some of the most commonly implicated drugs in emergency department visits and hospitalizations due to adverse drug events. Medication errors can significantly influence these events, and pharmacists are at the forefront for preventing medication errors from reaching the patient. Part 1 of this 2 part series on anticoagulation safety will focus on common medication errors involving direct oral anticoagulants. Part 2 will focus on ways pharmacists can help prevent medication errors with anticoagulants, particularly as it relates to anticoagulation stewardship programs.
Intravenous diltiazem infusions (i.e., “dilt drips”) are commonly used for the management of atrial tachyarrhythmias but they tend to cause as many problems as they resolve.
Rivaroxaban (Xarelto) is often touted as the go-to oral anticoagulant for non-adherent patients because of its once daily administration. In this entry, we explore whether this is true based on the drug’s pharmacokinetics.