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Uninterrupted Dabigatran versus Warfarin for Ablaiton in Atrial Fibrillation

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Student: Daniela Tobalina

Hello today i’m going to talk about uninterrupted dublicate rent versus warfarin for ablation in atrial fibrillation first i’m going to talk about the definition atrial fibrillation af or afib is an abnormal heart rhythm characterized by rapid and irregular bleeding of the atria it often starts as brief periods of abnormal bleeding which become longer and possibly

Constant over time often episodes have no symptoms occasionally there might there may be hard palpitations painting lightheadedness shortness of breath or chest pain the disease is associated with an increased risk of heart failure dementia and stroke it is a type of super ventricular tachycardia a healthy heart works continuously to pump blood around the body by

Beating regularly under the control of electrical impulses that originate from the sinoatrial or sa node the hearts natural pacemaker these impulses radiate from the top to the bottom of the heart in a coordinated way each heartbeat consists of two stages where blood enters the atria which subsequently contract and forces blood into the ventricles these in turn

Also contract forcing blood out of the heart into the pulmonary and systemic circulation in atrial fibrillation electrical impulses do not originate in the sinoatrial or sa node but from a different part of the atrium or in the nearby pulmonary veins these abnormal electrical signals become rapid and disorganized radiating through the atria walls in an uncoordinated

Manner this can cause the walls of the atria to fibrillate or quiver rapidly rather than contracting normally electrical signals are transmitted irregularly from the atria to the ventricles which both fail to contract in a synchronized way during atrial fibrillation because the atria do not contract regularly blood does not empty efficiently into the ventricles and

Begins to pull in the atria especially in the atrial appendage ‘as this pooling of blood can cause clots to form which if dislodged can travel in the bloodstream towards the brain the clots or embolus can potentially obstruct narrow blood vessels often the middle cerebral artery or its branches and prevent the normal flow of blood the reduced supply of blood and

Oxygen to a particular part of the brain can results in tissue death leading to ischemic stroke applications in medicine medications are up and prescribed to prevent and treat blood clots which can lead to a stroke additional drugs may be prescribed to control heart rate and rhythm in the afib patient these medications may also be used in conjunction with other

Treatments the heart rhythm can be more difficult to control the longer you have untreated afib the less likely it is that normal rhythm can be re-established medication medication options may include blood thinners rate controllers and rhythm controllers drugs such as blood thinners are given to patients to prevent blood clot formation or to treat an existing blood

Clot examples include warfarin other fda-approved anticoagulants such as tava catrin rivaroxaban a doc 7 and epic 7 direct-acting oral anticoagulants or the oac s aspirin in rare cases hello and welcome to videoscript’ presented by today we are reviewing pradaxa generically known as to bring a tran the fda-approved pradaxa on anticoagulant in october of

2010 to reduce the risk of blood clots and stroke and adult patients with atrial fibrillation not due to a heart valve problem patients with atrial fibrillation or afib have your regular heartbeats and are in a greater risk of developing a blood clot that may lead to a stroke pradaxa works as a direct thrombin inhibitor and blocks the conversion of fibrinogen into

Fibrin this action helps to prevent the formation of a clot unlike warfarin pradaxa does not require regular blood tests to check that therapeutic effect however there are some safety concerns pradaxa should not be used in patients who have active bleeding kidney function should be evaluated prior to the start of pradaxa therapy and in some cases yearly thereafter

Pradaxa should be stopped for certain procedures or surgery but should be restarted as soon as possible because pradaxa is an anticoagulant it can also lead to serious or fatal bleeding pradaxa should be used cautiously in patients older than 75 years of age in kidney impairment and in patients with a history of a stomach ulcer or bleeding other common side effects

Include dyspepsia also known as heartburn and other gastritis like symptoms in patients with kidney impairment reduce doses may be needed there are important drug interactions with pradaxa rifampin should not be used with pradaxa as it may lead to a decreased therapeutic effect with pradaxa a lower dose or discontinuation of pradaxa may be needed in patients with

Kidney impairment who take certain medications such as malta or ketoconazole use caution when combining pradaxa with other drugs that increase their risk for bleeding such as nsaids like ibuprofen or naproxen aspirin plavix or other blood thinners other drug interactions are noted in the package labeling and healthcare providers should check for all potential drug

Interactions prior to the start of pradaxa therapy pradaxa capsules must be kept dry to prevent the loss of potency store pradaxa in its original bottle and dispose of any unused medication for months after opening patients who received more than one bottle of pradaxa should only open one bottle at a time the capsule should be swallowed whole patients should not

Break open chew or empty the pellets from the capsules patients should not stop taking pradaxa unless directed to do so by their physician as this may increase the risk of stroke thank you for joining us at for a brief review of pradaxa please refer to our patient and professional information drug interaction checker and additional tools on

Patients with a concern about the use of pradaxa should consult with their health care provider visit slash pradaxa for more information issue applied in ecuador the work cardiac diseases that most occur in ecuador are heart failure myocardial infarction atrial fibrillation and hypertension in ecuador the for heart diseases affected approximately 1.4

Million people in 2015 the cost of caring for sick people with cardiac pathologies was higher than 600 million dollars in 2015 which represented a loss of a zero point six percentage points of the gross domestic product and 2.5 percent of the costs of the health sector heart failure imposes the highest financial cost with 228 million dollars followed by myocardial

Infarction with 227 million dollars hypertension with 97 million dollars and finally atrial fibrillation with 69 million dollars the topic this was alive alex our comprehensive approach to different i call it in solution for the eight nia so there are cases of leisure population of ventricular tachycardia implantable devices to address with the audience all the

Technical aspect of this procedure by using the latest technology the international center cabin still has restate our technology and they’ve been involved for now for a long time in testing also a new technology before get ready very i feel very comfortable in coming here in new cases because i know that the type of support in the instrument that they have access to

Is the same under player united states the importance of living center like this is that that’s the only way you can guarantee quality center with lower volume where there is no systematic approach or access to the newest technology cannot provide the best care to a patient with arrhythmia so the important this is very important aside without the support this year

In accessing new technology and also this participe build by doing a large volume it’s very important in the outcome of the procedure with you so it’s very important for the patient and for the people who live down there what we have seen in the last decade is a variability but first always more awareness of little problem and also better to diagnose there and this

Is very important because it’s the best way to prevent side-effect of all people problem so patient can have access to treatment proper treatment before they actually find out that everything from because they developed a complication for example a stroke from atrial fibrillation after a year whatever like threatening event from the trigger and so having access to

Way to document the presence of a problem before patient should develop side effect of the complication of the improvement i’m going to talk about the pros and cons pros first predictable pharmacokinetics rapid onset and offset of actions low potential for drug drug and drug dietary interactions does not require routine laboratory coagulation monitoring less side

Effects and warfarin less risk of major bleeding events cons no specific antidote exists in the event of overdose clinical consequences of non adherence are unknown viability can be dangerously increased when the pellets are administered with other capsule shell catheter ablation is an invasive procedure used to treat patients with symptomatic atrial fibrillation

Or af complications associated with atrial ablation include perry procedural stroke and transient ischemic attack heparin is administered during the procedure and traditionally warfarin has been used before and after the procedure to reduce the risk of perry procedural events the role of the newer non vitamin k oral anticoagulants has been unclear the research

At trial is a multicenter open label study that randomized 635 patients undergoing catheter ablation for af to receive therapeutic doses of warfarin or 150 milligrams of dabigatran a non vitamin k oral anticoagulant twice a day all patients received uninterrupted anticoagulation for four to eight weeks before and then during the procedure and for a further eight

Weeks after ablation the primary endpoint major bleeding events by the end of the treatment period occurred in one point six percent of the patients treated with dabigatran as compared with six point nine percent of those receiving warfarin the absolute risk difference between the two groups was statistically significant the composite incidence of major bleeding

Events and thromboembolic events was lower in the dabigatran group than in the warfarin group serious adverse events such as atrial flutter congestive heart failure and cardiac tamponade were reported in eighteen point six percent of the patients treated with dabigatran as compared with twenty two point two percent of the patients treated with warfarin the authors

Conclude that among patients undergoing catheter ablation for af harry procedural anticoagulation with uninterrupted too big a tran is safe and leads to fewer bleeding complications than uninterrupted warfarin full trial results are available at any jm or concussion in patients undergoing ablation for atrial fibrillation anticoagulation with uninterrupted abaca

Trent was associated with fewer bleeding complications that than uninterrupted warfarin naviga trent was associated with fewer very procedural pericardial tamponade and groin hematoma and warfarin the research study is a very important study because it’s a multicenter international randomized control trial comparing the bigger trend at x elite and their suggested

Warfarin in patients undergoing an ablation procedure previously doctors have felt that they had to change to a vitamin k antagonists or use bridging techniques or perhaps dropping doses of a noack thoroughly prior to ablation procedures because they’re worried about bleeding adverse events this trial was set up to compare their suggested warfarin and the big event

Absolutely uninterrupted so no tablets were dropped now the results were very interesting some 318 patients or there abouts in both groups were treated one with warfarin one with the big tremor texel eight in full doses 150 milligrams twice daily they were followed during the procedure and for eight weeks after the procedure to look specifically as a primary

Endpoint for major bleeding events defined using isth criteria the results were to my mind very interesting because there were 22 bleeding events in the warfarin group and there were only five with the bigger trend that excellent now this was statistically significant hazard ratio was 0.2 – there was a five point something percent absolute risk reduction which was

I think completely unexpected that the results would be as good as this now this trial has some implications it will stop cardiologists feeling insecure about using a no drugged it will mean that they don’t have to swap to a vitamin k antagonist with all the hazard that that encompasses if you do that it means that the bigger trend it takes are they can be used

Very safely continuously and therefore patients are not exposed to the risk of stroke by stopping the drug or reducing the dose it also has i think a much broader connotation that low risk relatively lower the procedures can be done safely on noack treatment rather than having to bridge or having to swap to a vitamin k antagonist so these results are important to

The electrophysiology community in particular but cardiologists and other physicians across the board thank you for listening

Transcribed from video
Uninterrupted Dabigatran versus Warfarin for Ablaiton in Atrial Fibrillation By Daniela Tobalina