Management of active bleeding in patients receiving anticoagulation
Management of AF in pregnancy
1-Rate vs. Rhythm control?
Answer: Rhythm control is preferred over rate control to avoid side effects of the drugs(Rhythm control is usually achieved by DC cardioversion).
2-Drugs used for rate control :
-Selective B1 blockers(metoprolol or bisoprolol) (class I)
-Calcium channel blockers(Verapamil)(class IIa)
-Digoxin (class IIa)
3-Drugs used for Rhythm control:
-Sotalol
-Propafenone or flecainide (for structually normal heart or pre-excitation)
NB:Amiodarone is contraindicated with pregnancy
4-Drugs used for anticoagulation:
Either therapeutic weight based LMWH or warfarin based on stage of pregnancy
NB:NOACs are contraindicated in pregnancy and lactation
I-First trimester:
LMWH or warfarin if dose less than 5mg
II-Second trimester until 36 weeks:
Warfarin
III-After 36 weeks to 36 hours before delivery:
LMWH
IV-36 hours before and After deliverly:
UFH infusion
(stop 6 hours before delivery)
(instead of the UFH strategy, you can stop LMWH 24 hours before delivery if low risk for thromboembolism)
5-The decision for giving anticoagulation is based on CHADS-VASc score
Reference: ESC guidelines for management of CVD with pregnancy 2018
#CQtips
By Dr Ahmed Mohsen
1-Rate vs. Rhythm control?
Answer: Rhythm control is preferred over rate control to avoid side effects of the drugs(Rhythm control is usually achieved by DC cardioversion).
2-Drugs used for rate control :
-Selective B1 blockers(metoprolol or bisoprolol) (class I)
-Calcium channel blockers(Verapamil)(class IIa)
-Digoxin (class IIa)
3-Drugs used for Rhythm control:
-Sotalol
-Propafenone or flecainide (for structually normal heart or pre-excitation)
NB:Amiodarone is contraindicated with pregnancy
4-Drugs used for anticoagulation:
Either therapeutic weight based LMWH or warfarin based on stage of pregnancy
NB:NOACs are contraindicated in pregnancy and lactation
I-First trimester:
LMWH or warfarin if dose less than 5mg
II-Second trimester until 36 weeks:
Warfarin
III-After 36 weeks to 36 hours before delivery:
LMWH
IV-36 hours before and After deliverly:
UFH infusion
(stop 6 hours before delivery)
(instead of the UFH strategy, you can stop LMWH 24 hours before delivery if low risk for thromboembolism)
5-The decision for giving anticoagulation is based on CHADS-VASc score
Reference: ESC guidelines for management of CVD with pregnancy 2018
#CQtips
By Dr Ahmed Mohsen