Antithrombotic therapy in atrial fibrillation associated with valvular heart disease: a joint consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology Working Group on Thrombosis, endorsed by the ESC Working Group on Valvular Heart Disease, Cardiac Arrhythmia Society of Southern Africa (CASSA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE)
Por:
Lip, GYH, Collet, JP, de Caterina, R, Fauchier, L, Lane, DA, Larsen, TB, Marin, F, Morais, J, Narasimhan, C, Olshansky, B, Pierard, L, Potpara, T, Sarrafzadegan, N, Sliwa, K, Varela, G, Vilahur, G, Weiss, T, Boriani, G, Rocca, B, Gorenek, B, Savelieva, I, Sticherling, C, Kudaiberdieva, G, Chao, TF, Violi, F, Nair, M, Zimerman, L, Piccini, J, Storey, R, Halvorsen, S, Gorog, D, Rubboli, A, Chin, A, Scott-Millar, R, ESC Sci Document Grp
Publicada:
1 nov 2017
Resumen:
Atrial fibrillation (AF) is a major worldwide public health problem, and AF in association with valvular heart disease (VHD) is also common. However, management strategies for this group of patients have been less informed by randomized trials, which have largely focused on 'non-valvular AF' patients.
Thrombo-embolic risk also varies according to valve lesion and may also be associated with CHA(2)DS(2)VASc score risk factor components, rather than only the valve disease being causal.
Given marked heterogeneity in the definition of valvular and non-valvular AF and variable management strategies, including non-vitamin K antagonist oral anticoagulants (NOACs) in patients with VHD other than prosthetic heart valves or haemodynamically significant mitral valve disease, there is a need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD.
To address this topic, a Task Force was convened by the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Thrombosis, with representation from the ESC Working Group on Valvular Heart Disease, Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulacion Cardiaca gamma Electrofisiologia (SOLEACE) with the remit to comprehensively review the published evidence, and to publish a joint consensus document on the management of patients with AF and associated VHD, with up-to-date consensus recommendations for clinical practice for different forms of VHD.
This consensus document proposes that the term 'valvular AF' is outdated and given that any definition ultimately relates to the evaluated practical use of oral anticoagulation (OAC) type, we propose a functional Evaluated Heartvalves, Rheumatic or Artificial (EHRA) categorization in relation to the type of OAC use in patients with AF, as follows: (i) EHRA Type 1 VHD, which refers to AF patients with 'VHD needing therapy with a Vitamin K antagonist (VKA); and (ii) EHRA Type 2 VHD, which refers to AF patients with 'VHD needing therapy with a VKA or a Non-VKA oral anticoagulant (NOAC)', also taking into consideration CHA(2)DS(2)VASc score risk factor components.
This consensus document also summarizes current developments in the field, and provides general recommendations for the management of these patients based on the principles of evidence-based medicine.
Filiaciones:
Lip, GYH:
Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England
Aalborg Univ, Dept Clin Med, Aalborg Thrombosis Res Unit, EHRA, Aalborg, Denmark
Collet, JP:
Sorbonne Univ Paris 6, ACT Study Grp, Inst Cardiol, Grp Hop Pitie Salpetriere,APHP,INSERM UMR 1166, Paris, France
de Caterina, R:
Univ G dAnnunzio, Inst Cardiol, Chieti, Italy
Fauchier, L:
Univ Tours, Ctr Hosp Univ Trousseau, Tours, France
Lane, DA:
Univ Tours, Fac Med, Tours, France
Aalborg Univ, Aalborg Thrombosis Res Unit, Dept Clin Med, Aalborg, Denmark
Larsen, TB:
Aalborg Univ Hosp, Thrombosis Res Unit, Dept Clin Med, Aalborg, Denmark
Marin, F:
Hosp Univ Virgen de la Arrixaca, Murcia, Spain
Morais, J:
Leiria Hosp Ctr, Dept Cardiol, Leiria, Portugal
Narasimhan, C:
Care Hosp, Dept Cardiac Electrophysiol, Hyderabad, Andhra Prades, India
Olshansky, B:
Mercy Hosp, Mason City, IA USA
Pierard, L:
Univ Hosp Sart Tilman, Dept Cardiol, Liege, Belgium
Potpara, T:
Univ Belgrade, Sch Med, Belgrade, Serbia
Clin Ctr Serbia, Cardiol Clin, Belgrade, Serbia
Sarrafzadegan, N:
Isfahan Univ Med Sci, Cardiovasc Res Inst, Isfahan Cardiovasc Res Ctr, WHO Collaborating Ctr, Esfahan, Iran
Univ British Columbia, Sch Populat & Publ Hlth, Vancouver, BC, Canada
Sliwa, K:
Univ Cape Town, Fac Hlth Sci, Hatter Inst Cardiovasc Res Africa, Rondebosch, South Africa
ACU, Mary McKillop Inst, Melbourne, Vic, Australia
Varela, G:
Ctr Cardiovasc Casa Galicia, Serv Electrofis, Hidalgos, Uruguay
Vilahur, G:
Hosp Santa Creu & Sant Pau, IIB St Pau, CiberCV, Cardiovasc Sci Inst ICCC, Barcelona, Spain
Weiss, T:
Wilhelminenhosp, Med Dept Cardiol & Intens Care, Vienna, Austria
Sigmund Freud Univ, Med Fac, Vienna, Austria
Boriani, G:
Univ Modena & Reggio Emilia, Cardiol Dept, Policlin Modena, Modena, Italy
Rocca, B:
Catholic Univ, Sch Med, Inst Pharmacol, ESC Working Grp Thrombosis, Rome, Italy
Gorenek, B:
Eskisehir Osmangazi Univ, Eskisehir, Turkey
Savelieva, I:
St Georges Univ London, Mol & Clin Sci Inst, London, England
Sticherling, C:
Univ Basel Hosp, Dept Cardiol, Basel, Switzerland
Chao, TF:
Taipei Vet Gen Hosp, Dept Med, Div Cardiol, Taipei, Taiwan
Natl Yang Ming Univ, Cardiovasc Res Ctr, Inst Clin Med, Taipei, Taiwan
Violi, F:
Univ Roma La Sapienza, Rome, Italy
Nair, M:
Max Super Specialty Hosp, Dept Cardiol, New Delhi, India
Zimerman, L:
Univ Fed Rio Grande do Sul, Hosp ClUnicas Porto Alegre, Porto Alegre, RS, Brazil
Piccini, J:
Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC 27706 USA
Storey, R:
Univ Sheffield, Dept Cardiovasc Sci, Sheffield, S Yorkshire, England
Halvorsen, S:
Natl Heart & Lung Inst, Imperial Coll, London, England
Univ Hertfordshire, Postgrad Med, Hatfield, Herts, England
Gorog, D:
Univ Oslo, Dept Cardiol, Hosp Ulleval, Oslo, Norway
Rubboli, A:
Osped Maggiore Bologna, Div Cardiol, Bologna, Italy
Chin, A:
Univ Cape Town, Groote Schuur Hosp, Electrophysiol & Pacing, Cape Town, South Africa
Scott-Millar, R:
Univ Cape Town, Div Cardiol, Dept Med, Cape Town, South Africa
Bronze, Green Published
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