CLINICAL MANAGEMENT GUIDELINE

Atrial fibrillation

ICD10: Unspecified atrial fibrillation and atrial flutter [I48.9]

Treatment: Anticoagulation management.

Identified as electrical chaos; it is a from of unpatterned depolarization of atrial tissues caused by multiple micro reentry circuits.

ECG findings: absent P waves, fibrillatory waves, and irregularly irregular QRS complexes.

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May manifests as palpitations, dyspnoea, angina, dizziness, syncope, and/or features of congestive heart failure, stroke, and death.

Risk factors:

  • Coronary artery disease.

  • Cardiac hypertrophy.

  • Rheumatic heart disease.

Refernce


Indications for immediate anticoagulation:

  1. AF in a hemodynamically unstable patient.
  2. CHADS2-VASc score ≥2. calculator
  3. +ve atrial clot on TEE.
  4. AF with cardiac comorbidities.
  5. Undergoing cardioversion.

Succesful criteria:

  1. INR 2-3.

How to use levels:

Level 1 is for all patients with no mechanical heart disease, severe renal failure, or have a SAMe-TT2R2 score > 2.

Level 2 is for the rest of Afib population.

Treatments

Level 1 / 2
pharmacological
dabigatran
ROUTE
Oral
DOSE
150.000 mg
FREQUENCY
BID
pharmacological
apixaban
ROUTE
Oral
DOSE
5.000 mg
FREQUENCY
BID

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  • Duplicating mechanism of action of effect
  • Weight based dosing
  • Contraindication
  • Renal dosing
  • Interactions to drugs or diseases
  • Hepatic dosing

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