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Core Curriculum

• Impact of vascular biology on cardiovascular disease, risk prevention, and treatment Section I: Atrial fibrillation, anticoagulation, and stroke prevention

The VBWG Core Curriculum 2004: Impact of vascular biology on cardiovascular disease, risk prevention, and treatment. Volume VI. This edition of the core curriculum is special, because it marks the 10th anniversary of the Vascular Biology Working Group. It covers basic science and clinical advances in vascular biology in a spectrum of disorders. The material is presented in five sections:

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is a major cause of cardioembolic stroke. The slides and accompanying notes in this section provide information on the rising incidence of this condition, the mechanism of thrombus formation, and new anticoagulant treatment options.



03VBWGAFCoreS001.pdf (0.5MB)03VBWGAFCoreS001.pdf (0.5MB)

A. Epidemiology update:

Download 03VBWGAFCoreS001.ppt (5 slides - 1.1MB)

A. Epidemiology update: ATRIA: Prevalence of AF by age and sex ATRIA: Projected number of patients with AF Hospitalizations for AF are increasing Mortality and AF

A. Epidemiology update:

Download 03VBWGAFCoreS002.ppt (8 slides - 1.5MB)

A. Epidemiology update: Stroke risk is increased in AF Severity of stroke with AF Framingham risk score: Relation to 5-year stroke risk Framingham risk score: Relation to 5-year risk of stroke/death Impact of selected AF risk factors on predicted 5-year risk of stroke/death LV systolic dysfunction on echocardiography predicts stroke in AF patients SPAF III: Stroke/systemic embolism event rates according to TEE findings

B:Vascular biology

Download 03VBWGAFCoreS003.ppt (6 slides - 1.3MB)

B:Vascular biology Potential prothrombotic mechanisms in AF: ↓ NO production Potential prothrombotic mechanisms in AF: LAA stasis Stroke mechanisms in AF: Proposed unifying model Effect of anticoagulation intensity on post-stroke survival in patients with AF AFFIRM: Effect of anticoagulation intensity on stroke risk

C. ACC/AHA/ESC guidelines

Download 03VBWGAFCoreS004.ppt (3 slides - 0.7MB)

C. ACC/AHA/ESC guidelines ACC/AHA/ESC guidelines for AF management: Recurrent paroxysmal AF ACC/AHA/ESC guidelines for AF management: Recurrent persistent and permanent AF

D. Current clinical options Warfarin: Issues and challenges

Download 03VBWGAFCoreS005.ppt (8 slides - 1.7MB)

D. Current clinical options Warfarin: Issues and challenges Aspirin in AF: Stroke risk reductions Oral anticoagulants vs aspirin for stroke prevention in AF Coagulation cascade Anticoagulant action of warfarin: Slow onset Warfarin: Narrow therapeutic window Limitations of warfarin Warfarin limitations lead to under-treatment of AF

E. Emerging new options Profile of direct thrombin inhibition

Download 03VBWGAFCoreS006.ppt (36 slides - 6.6MB)

E. Emerging new options Profile of direct thrombin inhibition Rationale for direct thrombin inhibition: A new anticoagulant strategy Prothrombotic effects of thrombin Coagulation cascade: Central role of thrombin Thrombin binding sites Direct thrombin inhibitor specificity for the active site Heparins and direct thrombin inhibitors: Mechanisms of action Direct thrombin inhibitors block both circulating and clot-bound thrombin Characteristics of direct thrombin inhibitors Direct thrombin inhibitors Ximelagatran pharmacokinetics Benefits of ximelagatran SPORTIF III and V: Stroke Prevention using an ORal Thrombin Inhibitor in atrial Fibrillation SPORTIF III and V: Objective and design SPORTIF III and V: Non-inferiority testing SPORTIF III and V: Inclusion criteria SPORTIF III: Quality of warfarin control SPORTIF III: Primary outcome (stroke and systemic embolism)-Intention-to-treat analysis SPORTIF III: Primary outcome (stroke and systemic embolism)-On-treatment analysis SPORTIF III: Event rate comparisons for secondary composite outcomes SPORTIF III: Incidence of hemorrhage SPORTIF III: Incidence of liver enzyme elevation SPORTIF III: Net clinical benefit SPORTIF V: Quality of warfarin control SPORTIF V: Primary outcome (stroke and systemic embolism)-Intention-to-treat analysis SPORTIF V: Primary and sensitivity analyses SPORTIF V: Incidence of hemorrhage SPORTIF V: Incidence of liver enzyme elevation SPORTIF III and V pooled results: Primary outcome SPORTIF III and V pooled results: Incidence of major bleeding SPORTIF III and V pooled results: Net clinical benefit SPORTIF III and V: Conclusions THRIVE III: Extended secondary prevention of VTE with ximelagatran THRIVE III: Incidence of hemorrhage THRIVE III: Time course of liver enzyme elevation THRIVE III: Conclusions
Published by Medical Education Consultants, LLC (MEDCON), on behalf of the University of Florida College of Medicine.

The editorial content of this program does not necessarily reflect the views or recommendations of the University of Florida College of Medicine or AstraZeneca, King Pharmaceuticals Inc, Pfizer Inc, and Wyeth Pharmaceuticals, or the publisher. The reader is advised to consult the full prescribing information of each product prior to use.

This program was prepared and produced by Medical Education Consultants, LLC, Westport, Connecticut, on behalf of the University of Florida College of Medicine through an unrestricted educational grant provided by AstraZeneca, King Pharmaceuticals Inc, Pfizer Inc, and Wyeth Pharmaceuticals.

©2004 Medical Education Consultants, LLC (MEDCON). All rights reserved.

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