Thread by @Dr_DanMD

#FITSurvivalGuide #ACCFIT

1/10: Stroke🧠 prevention in afib. #warfarin, #noacs, & LAA occlusion devices.

◽️shared decision making is key 🔑
◽️CHADS-Vasc to stratify risk
◽️factor 💸and CrCl 🚽
◽️DAPT+AC= ↑↑bleeding

https://twitter.com/HeartToProve/status/1015268373817647105

https://twitter.com/steph_achenbach/status/1019454275045519361?s=21

2/10
For a quick review on coagulation physiology as it pertains to AC see 📽below.

@dr_chirumamilla @Pooh_Velagapudi @bcostelloMD @majazayeri @fawazalenezi55 @SanChris999 @GuruKowlgi @Nidhi_Madan9 @sabeedak1 @noshreza
@SaggerMawri @nsivcd @DrManiCardio @khandelwalMD @drjohnm

3/10
Warfarin 🐀☣️
◽️interferes with normal post translational gamma-carboxylation of vitamin K dependent clotting factors 2️⃣7️⃣9️⃣🔟

◽️doesn’t inactivate functional clotting factors
◽️prothrombin half life: 72h
◽️Ergo INR effect 24-36 hr
🛑 teratogenic

4/10
For "Valvular afib": Warfarin & LMWH
◽️rheumatic MS
◽️mechanical or mitral valve
◽️mitral valve repair

🛑Class3️⃣: no NOACs for valvular afib. RE-ALIGN

@heartdoc45 @zainasadEP  @docaward @yogitar @KevinShahMD
@sairasamani @sarahhudsonuk @avolgman @rahatheart1

5/10
Data for NOACs vs warfarin in AFib

◽️Dabigatran- RELY
◽️Rivaroxaban- ROCKET AF 🚀
◽️Apixaban- ARISTOTLE, AVERROES
◽️Edoxaban- ENGAGE AF TIMI48

@sunnyvmd @monsangh @feelingthepulse @achoiheart
@akshitsharmaMD @adcaTicTocDoc @rezaemaminia @MartyTamMD @true_EP

6/10
In NOACS: Pay attention⚠️
◽️To CrCl 🚽
◽️💊 interactions
◽️BMI ⚖️
◽️ pharmacokinetic profiles vary 👇

Reversal ◀️
◽️Idarucizumab ◀️dabigatran
◽️Andexanet Alfa◀️Xa Inhibitors *news*🥂

@onco_cardiology @sheelakrishmd @skilicmd @ekgpdx @chadialraies

7/10
NOAC advantages:
◽️lower bleeding risk
◽️no lab monitoring 💉
◽️not dependent on vit K

Warfarin advantages:
◽️cost
◽️ok in renal impairment
◽️easily reversable

@mirvatalasnag @venkmurthy @fischman_david @DrToniyaSingh @DrMarthaGulati @VietHeartPA @Regadenoson

8/10
LA appendage: source of embolization and thrombus formation due to:
◽️intense fibrosis and inflammation
◽️pectinate muscle

Consider for:
◽️↓plts, coagulopathy
◽️recurrent bleeding
◽️intolerance of AC
◽️high risk or prior falls

@cardiojaydoc02 @mark_kaeppler

9/10
Various ways to exclude the LAA👇

◽️LARIAT
◽️WATCHMAN (preferred @HopkinsMedicine)
◽️AMPLATZER Cardiac Plug
◽️Surgical removal

@mmamas1973 @CMichaelGibson @DocSavageTJU @rajivxgulati @SVRaoMD @MinnowWalsh @DrKevinCampbell @krishmd @cardiodee @DrLaxmiMehta @ash71us

10/10
That's a wrap for today! Hopefully with the right strategy we can save 🧠and keep 🧡 happy😍!

Your pharmacist is your friend🤝! Thanks to @johnplinds, Jess Chasler, @kdane_pharmd !

Definitely recommend this #acc app
itunes.apple.com/us/app/acc-gui…

https://twitter.com/HeartToProve/status/1015268373817647105

https://twitter.com/steph_achenbach/status/1019454275045519361?s=21