Course:PHAR451/StrokePrevention-AtrialFibrillation

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Stroke Prevention Therapeutics in Atrial Fibrillation
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PHAR 451
Section:
Instructor: Dr. Peter Loewen
Email: peter.loewen@ubc.ca
Office: PHRM 6624
Office Hours:
Class Schedule: November 17, 2014
Classroom: PHRM 1101
Important Course Pages
Syllabus
Lecture Notes
Assignments
Course Discussion


Ischemic Stroke Prevention Therapeutics in Atrial Fibrillation

Pre-Session Objectives

PRIOR TO arriving at the session, participants should be able to name the stroke-applicable drugs, usual dose ranges, and common toxicities of all the following drugs:

  • aspirin
  • warfarin
  • dabigatran
  • rivaroxaban
  • apixaban
  • edoxaban
  • clopidogrel

Preparation for the session

Use SPARCTOOL.COM to estimate the stroke risk off and on each of the viable therapeutic options for the following patients. In your opinion, which would be the most appropriate stroke prevention therapy in each?

Case #1: 70 y/o M with chronic AF, mild HTN.

Case #2: 67 y/o M with AF.

Case #3: 72F presents to your emergency department 4 hours after noticing aphasia and right-sided hemiparesis. No impairment of consciousness. Diagnosis: Acute ischemic stroke. PMH: HTN, atrial fibrillation, DM2. CAD (MI 2 months ago). One week later, the patient’s neurological status has stabilized (modified Rankin scale 1).

Case #4: 85 y/o F with ischemic stroke while on ASA 325 mg/d. Stroke is presumed to be AF-associated cardioembolism.

Case #5: 83 y/o M with AF, CHF, HTN, poor renal function.

Case #6: 70 y/o F with new-onset AF; MI 1 month ago with DES (on ASA+clop); HTN; EF 30%; CrCL ~30 mL/min;

Case #7: ID/CC/HPI: 80F presents with global aphasia, oriented x 0, some impairment of consciousness (GCS 8), R-sided hemiparesis. History from her son reveals that symptoms onset suddenly 2 hours ago. PMH: Atrial fib, CVA 2 years ago. Meds PTA: Warfarin 3mg daily, simvastatin 40mg HS, furosemide 40mg daily, ramipril 5mg daily. Diagnosis: intracerebral hemorrhage.

  • What if the CT showed a cardioembolic ISCHEMIC stroke instead?
  • What if the CT showed a cardioembolic ISCHEMIC stroke instead, and she had a mechanical valve in place?

Objectives

After the session, and upon personal reflection & study, students will be able to: DESIGN and RATIONALIZE using EVIDENCE, a stroke prevention regimen (drugs, doses, routes, frequency) for a patient with atrial fibrillation which incorporates their stroke risk, bleeding risk, access to coverage, personal values, and ability to be monitored.

Session Materials

Supportive Literature, Resources, Further Reading

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