2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation  Jason G. Andrade, MD, Atul Verma, MD, L. Brent Mitchell, MD, Ratika Parkash, MD, Kori Leblanc, ACPR, PharmD, Clare Atzema, MD, Jeff S. Healey, MD, Alan Bell, MD, John Cairns, MD, Stuart Connolly, MD, Jafna Cox, MD, Paul Dorian, MD, David Gladstone, MD, M. Sean McMurtry, MD, Girish M. Nair, MBBS, Louise Pilote, MD, Jean-Francois Sarrazin, MD, Mike Sharma, MD, Allan Skanes, MD, Mario Talajic, MD, Teresa Tsang, MD, Subodh Verma, MD, D. George Wyse, MD, PhD, Stanley Nattel, MD, Laurent Macle, MD  Canadian Journal of Cardiology  Volume 34, Issue 11, Pages 1371-1392 (November 2018) DOI: 10.1016/j.cjca.2018.08.026 Copyright © 2018 Canadian Cardiovascular Society Terms and Conditions

Figure 1 Oral anticoagulation pathway in the context of cardioversion for atrial fibrillation or flutter. AF, atrial fibrillation; CCS, Canadian Cardiovascular Society; CHADS2, Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack; LA, left atrial; NVAF, nonvalvular atrial fibrillation; OAC, oral anticoagulant; TEE, transesophageal echocardiogram. Canadian Journal of Cardiology 2018 34, 1371-1392DOI: (10.1016/j.cjca.2018.08.026) Copyright © 2018 Canadian Cardiovascular Society Terms and Conditions

Figure 2 Risk factors associated with an increased risk of bleeding, and an increased risk of ischemic coronary outcomes (recurrent myocardial infarction, stent thrombosis). ACS, acute coronary syndrome; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; INR, international normalized ratio; LAD, left anterior descending artery; NSAID, nonsteroidal anti-inflammatory drug; NSTEMI, non–ST-elevation myocardial infarction; OHG, oral hypoglycemic agents; STEMI, ST-elevation myocardial infarction; TTR, Time in Therapeutic Range; UA, unstable angina. Canadian Journal of Cardiology 2018 34, 1371-1392DOI: (10.1016/j.cjca.2018.08.026) Copyright © 2018 Canadian Cardiovascular Society Terms and Conditions

Figure 3 Management of antithrombotic therapy in patients with atrial fibrillation (AF) and coronary artery disease (CAD)/peripheral artery disease (PAD). ACS, acute coronary syndrome; ASA, acetylsalicylic acid; BID, twice per day; BMS, bare metal stent; BVS, bioabsorbable vascular scaffold; CCS, Canadian Cardiovascular Society; CHADS2, Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack; CrCl, creatinine clearance; CV, cardiovascular; DES, drug-eluting stent; eGFR, estimated glomerular filtration rate; INR, international normalized ratio; NOAC, non-vitamin K antagonist oral anticoagulant; OAC, oral anticoagulant; PCI, percutaneous coronary intervention; PO, orally. Canadian Journal of Cardiology 2018 34, 1371-1392DOI: (10.1016/j.cjca.2018.08.026) Copyright © 2018 Canadian Cardiovascular Society Terms and Conditions

Figure 4 The simplified Canadian Cardiovascular Society (CCS) algorithm (CHADS-65) for deciding which patients with atrial fibrillation (AF) or atrial flutter should receive oral anticoagulant (OAC) therapy. It recommends an OAC for most patients ≥ 65 years of age and for younger patients with a Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack (CHADS2) score ≥ 1; aspirin (acetylsalicylic acid [ASA]) for patients < 65 years of age with a CHADS2 score = 0 with arterial vascular disease (coronary, aortic, or peripheral); and no antithrombotic therapy for patients < 65 years of age with a CHADS2 score = 0 and no arterial vascular disease. Bleeding risks should be modified whenever possible. A non-vitamin K antagonist oral anticoagulant (NOAC) is recommended in preference to warfarin for OAC therapy in NVAF patients. CAD, coronary artery disease; INR, international normalized ratio; NSAID, nonsteroidal anti-inflammatory drug; TIA, transient ischemic attack. Canadian Journal of Cardiology 2018 34, 1371-1392DOI: (10.1016/j.cjca.2018.08.026) Copyright © 2018 Canadian Cardiovascular Society Terms and Conditions