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Oral Anticoagulant Update: Preventing Stroke in Older Adults with Atrial Fibrillation

NPWTDirect-acting Oral Anticoagulants and Guideline Updates: Preventing Stroke in Older Adults With Atrial Fibrillation- Nonvalvular atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice and afflicts more than 3 million people in the United States. AF is an independent risk factor for ischemic stroke severity, recurrence, and mortality. AF is a disease predominantly of older adults: the median age for AF patients is 73 to 75 years. Although most AF-related strokes could be prevented with anticoagulation therapy, many patients with AF are not receiving appropriate evidence-based therapy for stroke prevention. The goal of this monograph is to give consultant pharmacists the tools to overcome barriers to the use of anticoagulation therapy for the prevention of stroke in older adults with AF. Determine when a patient with atrial fibrillation is at risk for stroke using evidence-based risk scoring assessments. Discuss the risk of stroke versus the risk of intracranial bleeding from anticoagulant therapy in patients with AF. Compare the benefits and risks of warfarin and direct-acting oral anticoagulant anticoagulant medications. Discuss reversal agents for non-warfarin anticoagulant medications that are currently under late-stage investigation. Describe a patient who should remain on warfarin therapy and a patient who should be considered for direct-acting oral anticoagulant therapy. Outline current evidence for prescribing aspirin for the prevention of stroke in patients with AF.

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Supported by educational grants from Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb and Pfizer, Inc. and Daiichi Sankyo, Inc.