PASSO 01
DETERMINAÇÃO DA DOSE DE DOAC
SCORE HASBLED (RISCO HEMORRÁGICO)
Score CHDAVASC > 1
Não
Sim
Prótese mecânica
Não
0
Sim
+1
História atual ou prévia de estenose mitral moderada a grave/reumática
Não
0
Sim
+1
Idade
Peso (kg)
Diálise
Não
Sim
Creatinina sérica (mg/dL)
Prótese mecânica
Não
0
Sim
+1
História atual ou prévia de estenose mitral moderada a grave/reumática
Não
0
Sim
+1
Idade
Peso (kg)
Diálise
Não
Sim
Creatinina sérica (mg/dL)
Referências:
• Hindricks G et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. Eur Heart J. 2021 Feb 1;42(5):373-498.
• Steffel J et al. European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021 Oct 9
• Patti G et al. Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub-Analysis From the PREFER in AF (PREvention oF Thromboembolic Events-European Registry in Atrial Fibrillation). J Am Heart Assoc. 2017 Jul
• Caldeira D et al. Non-vitamin K antagonist oral anticoagulants in elderly patients with atrial fibrillation: A systematic review with meta-analysis and trial sequential analysis. Arch Gerontol Geriatr. 2019 Mar-Apr;81:209-214.
PASSO 02
RESUMO DOS CRITÉRIOS DE AJUSTE DE DOSE DE DOAC
Veja também o vídeo sobre como usar a calculadora, explicado pelo Prof. Doutor Ricardo Fontes de Carvalho
Referências:
• Hindricks G et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. Eur Heart J. 2021 Feb 1;42(5):373-498.
• Steffel J et al. European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021 Oct 9
• Patti G et al. Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub-Analysis From the PREFER in AF (PREvention oF Thromboembolic Events-European Registry in Atrial Fibrillation). J Am Heart Assoc. 2017 Jul
• Caldeira D et al. Non-vitamin K antagonist oral anticoagulants in elderly patients with atrial fibrillation: A systematic review with meta-analysis and trial sequential analysis. Arch Gerontol Geriatr. 2019 Mar-Apr;81:209-214.
PASSO 03
RESUMO DA ORIENTAÇÃO DO CASO CLÍNICO
NOVO GUIA PRÁTICO 2021 DE UTILIZAÇÃO DE NOACS: UTILIZAÇÃO DE NOACS EM DOENTES COM TROMBOCITOPENIA
Referências:
• Hindricks G et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. Eur Heart J. 2021 Feb 1;42(5):373-498.
• Steffel J et al. European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021 Oct 9
• Patti G et al. Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub-Analysis From the PREFER in AF (PREvention oF Thromboembolic Events-European Registry in Atrial Fibrillation). J Am Heart Assoc. 2017 Jul
• Caldeira D et al. Non-vitamin K antagonist oral anticoagulants in elderly patients with atrial fibrillation: A systematic review with meta-analysis and trial sequential analysis. Arch Gerontol Geriatr. 2019 Mar-Apr;81:209-214.
PASSO 05
ORIENTAÇÃO FINAL
Apixabano 5 mg, 2 tomas diárias
Parar ácido acetilsalicílico
Considerar uso profilático de inibidor da bomba de protões.
Reavaliação clínica (hemorragias) e analítica (hemograma) frequente
Referências:
• Hindricks G et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. Eur Heart J. 2021 Feb 1;42(5):373-498.
• Steffel J et al. European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021 Oct 9
• Patti G et al. Thromboembolic Risk, Bleeding Outcomes and Effect of Different Antithrombotic Strategies in Very Elderly Patients With Atrial Fibrillation: A Sub-Analysis From the PREFER in AF (PREvention oF Thromboembolic Events-European Registry in Atrial Fibrillation). J Am Heart Assoc. 2017 Jul
• Caldeira D et al. Non-vitamin K antagonist oral anticoagulants in elderly patients with atrial fibrillation: A systematic review with meta-analysis and trial sequential analysis. Arch Gerontol Geriatr. 2019 Mar-Apr;81:209-214.