353. Atrial Fibrillation: Anticoagulation Pharmacology & Clinical Decision-Making with Dr. Ashley Lochman and Dr. Chris Domenico

Anticoagulation management for atrial fibrillation requires nuanced decision-making, particularly when balancing stroke prevention against bleeding risks in complex patient populations. Direct oral anticoagulants (DOACs) serve as the preferred standard over warfarin for most non-valvular cases, though warfarin remains essential for patients with mechanical heart valves, moderate-to-severe mitral stenosis, or antiphospholipid syndrome. Clinical management of patients with comorbidities like obesity, cirrhosis, or chronic kidney disease necessitates careful selection of agents based on hepatic and renal clearance profiles. Furthermore, optimizing therapy for patients requiring concurrent antiplatelet and anticoagulant regimens involves transitioning from triple therapy to dual therapy to reduce bleeding complications without compromising ischemic protection. Experts Dr. Ashley Lochman and Dr. Chris Domenico emphasize that individualized care, informed by specific trial data and pharmacological expertise, remains the cornerstone of effective cardiovascular treatment.