Chapter 12: Preventing Cerebrovascular Events in Patients with Atrial Fibrillation: Drugs and Devices

(Guest Authored by Roger Kersten, DO, FACC)

Anticoagulation is an important consideration in electrophysiology since many patients require thromboembolic prophylaxis to prevent stroke and systemic embolization events. Patients with atrial fibrillation and/or atrial flutter who are at higher risk of thromboembolic events should be treated with anticoagulation unless otherwise contraindicated. The previously used CHADS2 scoring system for thromboembolic risk has been modified to the CHA2DS2-VASc risk factor assessment. This chapter shows the CHA2DS2-VASc scoring system, which is commonly used to risk stratify these patients. Regardless of whether their arrhythmia is paroxysmal or persistent, the thromboembolic risk remains similar. It is very common that patients seen and treated by electrophysiologists are on oral anticoagulants; therefore, it is important for members of the electrophysiology team to have a general understanding and awareness of the rationale for anticoagulation, especially in these patients. It is also important to be familiar with the types of medications, devices, and procedures used to lower thromboembolic risk.

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