Activity 1: Thromboprophylaxis in Atrial Fibrillation: Current Issues and Challenges

Program Overview

Prevention of thromboembolism in patients with atrial fibrillation (AF) is a key issue for the health care community.  However, studies show that identifying patients with AF who are at risk of stroke and the effective use of anticoagulants to prevent stroke pose challenges.1 Thromboprophylaxis in Atrial Fibrillation: Current Issues and Challenges reviews risk stratification and the role of anticoagulation therapy versus antiplatelet therapy to prevent stroke in patients with AF. 

Warfarin has long been the mainstay of anticoagulation therapy. In this activity, the faculty provide practical advice on optimizing warfarin therapy and improving patient adherence. In 2010, the first anticoagulant to serve as a viable alternative to warfarin was approved by the U.S. Food and Drug Administration (FDA); other new anticoagulants are in the pipeline. New options for anticoagulation therapy promise advantages such as fixed dosing, no need for blood level monitoring, and significantly fewer drug and food interactions. These new agents and their evolving therapeutic role are also discussed in this activity.

  1. Lip GY, Watson T.  Stroke prevention in atrial fibrillation -- things can only get better.  Br J Clin Pharmacol 2007;64:575-7.

Intended Audience

This continuing medical education program is intended for family physicians and other primary care providers who manage patients with atrial fibrillation.  

Learning Objectives

After completing this activity, family physicians will be better able to:

  • Demonstrate increased awareness of the range of assessment tools and evidence-based guidelines available to aid thrombotic risk stratification in AF and incorporate this knowledge into practice.
  • Describe the role of antithrombotic therapy in AF patients at risk of stroke and be aware of the implications of underprescribing.
  • Describe the safety and efficacy profile of the currently available antithrombotic therapies, including issues surrounding patient selection.
  • Describe the approach to dosing and therapeutic drug monitoring for antithrombotic therapy in AF patients at risk of stroke based on evidence-based guidelines and incorporate this knowledge into practice.  
  • Outline strategies for risk reduction in challenging patient populations and incorporate this knowledge into practice.  
  • Describe emerging antithrombotic therapies and other new developments in the prevention of stroke in AF, including issues surrounding patient selection and monitoring.


John Russell, MD
Associate Professor of Family and Community Medicine
Temple University School of Medicine
Philadelphia, PA
Associate Director, Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

Anthony Bavry, MD, MPH
Assistant Professor of Medicine
Division of Cardiovascular Medicine
University of Florida, Division of Medicine
Gainesville, FL

CME Accreditation

This enduring material activity, Thromboprophylaxis in Atrial Fibrillation: Current Issues and Challenges, (the first activity in the Thromboprophylaxis in Atrial Fibrillation series), has been reviewed and is acceptable for up to 1 Prescribed credit(s) by the American Academy of Family Physicians. This activity conforms to the AAFP criteria for evidence-based CME clinical content. AAFP accreditation begins June 1, 2011.  Term of approval is for 2 year(s) from this date with the option of yearly renewal.

The evidence-based CME content developed for this activity was based on practice recommendations that were the most current with the strongest level of evidence available at the time this activity was approved. Since some clinical research is ongoing, the American Academy of Family Physicians recommends that learners verify sources and review these and other recommendations prior to implementation into practice.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Academy of Family Physicians designates this enduring material for a maximum of 1 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Introduction and Opening Remarks
Module 1. Overview of Thromboprophylaxis in Atrial Fibrillation
Module 2. Choice of Thromboprophylaxis Agent
Module 3. Warfarin: Issues and Controversies
Module 4. 2011 and Beyond
Closing Remarks


It is the policy of the AAFP that all CME planning committee/faculty/authors/editors/staff disclose relationships with commercial entities upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest and, if identified, they are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity.

The AAFP and MedEd Architects, LLC staffs have indicated that they have no relationships to disclose relating to the subject matter of the activity.  Drs. Russell and Bavry returned disclosure forms indicating that they have no financial interest in or affiliation with any commercial supporter or providers of any commercial services discussed in this educational material.


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