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Antiplatelet or Anticoagulant: Do They Have the same Efficacy?

Antiplatelet or Anticoagulant: Do They Have the same Efficacy?. University of Central Florida Deborah Andrews RN, BSN. Purpose. To evaluate antiplatelet versus anticoagulant agents for prevention of thromboembolic stroke in atrial fibrillation patients Anticoagulants:

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Antiplatelet or Anticoagulant: Do They Have the same Efficacy?

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  1. Antiplatelet or Anticoagulant:Do They Have the same Efficacy? University of Central Florida Deborah Andrews RN, BSN

  2. Purpose • To evaluate antiplatelet versus anticoagulant agents for prevention of thromboembolic stroke in atrial fibrillation patients • Anticoagulants: • small therapeutic range • Underuse by health care providers • Non-compliance by patients

  3. BackgroundAtrial Fibrillation • Disorganized contractions that disrupt blood flow through the heart • 2.66 Million Americans • 2009 11,555 deaths attributed to AFib • Risk increases with age • 6.4 Billion dollars annually in U.S.

  4. Stroke • AFib increases risk by 5 fold • 159,000 annually attributed to AFib • Ischemia is responsible for 87% • Strokes regardless of cause cost Americans 23 Billion dollars annually • 24% of AFib patients not offered pharmacologic treatment

  5. Anticoagulant Agents • Warfarin reduces stroke by 60% • Inhibits Vitamin K clotting enzymes • Small therapeutic range • Multiple adverse effects • Only oral anticoagulant used in U.S.

  6. Antiplatelet Agents • Aspirin: Up to 20% Stroke reduction • COX inhibitor • Readily available, Inexpensive, Familiar • Adverse effects: GI, Bleeding, toxicity • New Antiplatelets: Clotting Cascade

  7. Research Question Do Antiplatelet Medications Have the Same Efficacy as Anticoagulants for Preventing Thromboembolic Events in Atrial Fibrillation patients?

  8. Relevance to Nursing • Management of Patient Medications • Availability to Patients • Compliance • Less Adverse Risks • Quality of Life for Patients • Need for Education • Lower Healthcare Costs

  9. Methods • Data Bases: • CINAHL Plus • MEDLINE • Cochrane Data Base of Systemic Reviews Google • Search Terms: • Anticoagulant, Antiplatelet • Atrial Fibrillation, Stroke • Prevention, Warfarin, Aspirin, Clopidogrel

  10. Definitions

  11. Criteria Inclusion Exclusion Duplicate Studies Published prior to 2000 Embolic events From Other Sources Intravenous agents Patients < 60 years Poor Quality • Published: 2000 - 2010 • AFib Patients >60 years • Available in English • Measurable Outcomes • Prevention of Thromboembolic Events • Oral agents • Randomized

  12. Methods

  13. Study Characteristics Findings

  14. Sample Characteristics

  15. Themes

  16. Validity of Findings

  17. Synopsis of Finding

  18. Synopsis of Findings Hart et al., 2007 & Mant et al., 2007

  19. Synopsis FindingsOAC Bover et al., 2009 & Hart et al. 2007

  20. Total of All Trials, 29,457 Patients 4.8% Stroke Rate Bover et al., 2009, Hart et al. ,2007, & Mant et al., 2007

  21. Time in Therapeutic Range • INR Ranges Varied Study to Study • Average Time in Therapeutic Range 67% - 69% (Meta-Analysis: undetermined) Bover et al., 2009, Hart et al. ,2007, & Mant et al., 2007

  22. Recommendations for Nursing

  23. Prospective Queries • Is Combination Therapy Better Than Monotherapy for Prevention of Ischemic Stroke? • Are the New Antiplatelet Agents Safer Than Warfarin?

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