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Medicine Grand Rounds - Stroke Prevention in Atrial Fibrillation: A Paradigm in Transition

Dr. Halperin describes the predispositions (atrial electrical and mechanical dysfunction, genetics) and triggers (alcohol, caffeine, inflammation) for the development of atrial fibrillation and possible thromboembolism. He discusses prescribing guidelines when balancing the risk of thrombus, antithrombotic therapy and the potential for intercranial bleed in the presence of afib. He scrutinizes the use of oral anticoagulants, how they differ from one another and from warfarin, and their reversal strategies. He is concerned that under-prescribing of antithrombotic therapy in afib is unnecessarily exposing patients to risk for debilitating injuries resulting from a stroke.

Activity Details

Start Date:  October 18, 2019
End Date:  October 18, 2021

You may claim CME credit for successful completion of this online course. In order to claim credit, you must follow these steps:

  1. Register for the learning activity by creating an account or logging in to your account.
  2. Click Continue to navigate to the Activity Material tab. Click View Presentation to view the recording. View the entire presentation.
  3. Return to this Activity page.
  4. Click Continue to navigate to the Evaluation tab; then click the Launch button to start the evaluation.
  5. Complete and Submit the evaluation and attestation form.

When the evaluation is submitted, you will be awarded credit. You may access your transcript for verification of participation at any time via Your Account. Need help? Visit the Support Page, send an Email, or call the Center for Learning and Professional Development at (603) 653-1234, Option 1.

  • Jonathan L. Halperin, MD
    Robert and Harriet Heilbrunn Professor of Medicine (Cardiology)
    The Cardiovascular Institute
    Mount Sinai Medical Center
    New York, NY

    About our presenter: 
    Jonathan L. Halperin, M.D. is the Director of Clinical Cardiology Services in the Zena and Michael A. Wiener Cardiovascular Institute at The Mount Sinai Medical Center. He also serves as Director of Mount Sinai's Urban Community Cardiology Fellowship Program.

    Dr. Halperin serves on numerous consensus and writing panels that issue clinical practice guidelines for management of patients with various cardiovascular disorders, including atrial fibrillation, peripheral arterial disease, cerebrovascular disease and stroke, and is a member of the ACC/AHA Task Force on Practice Guidelines.
Learning Outcome

Participants will be able to appreciate the implications of intrinsic atrial pathology for both the development of atrial fibrillation and its associated risk of thromboembolism, recognize the efficacy and limitations of the antithrombotic agents approved for stroke prevention, and know the available reversal strategies for target-specific oral anticoagulants.


Dartmouth-Hitchcock is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dartmouth-Hitchcock designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Requirements for Successful Completion

In order to receive credit for this Continuing Medical Education (CME) activity, you must:

  • View the entire presentation
  • Complete the online Attestation of Attendance & Evaluation Form (you must register to access).

In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.

The following Activity Physician Director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content for Stroke Prevention in Atrial Fibrillation: A Paradigm in Transition (Medicine Grand Rounds) have reported the following financial interest or relationship* with various companies/organizations. The Activity Director and Planning Committee member roles were resolved by altering the individual’s control over content about the products or services of the commercial interest by the Associate Dean for CME and the Department of Medicine Chair. The speaker conflict has been resolved by validating the activity content through independent peer review by Kelly Kieffer, MD. All potential conflict(s) were resolved.

* Kelly Kieffer, MD ~ her spouse is a consultant for OcculoBio. 

* Richard I. Rothstein, MD ~ has research support from Baranova (research grant to Dartmouth-Hitchcock Medical Center) and has other financial interest from Allurion. 

* Jonathan Halperin, MD ~ is a consultant to Bayer AG Healthcare, Boehringer Ingelheim, Johnson & Johnson, Ortho-McNeil-Janssen Pharmaceuticals, Abbott, Janssen and Medtronic. Dr. Halperin is the Deputy Editor for the Journal of the American College of Cardiology, he was the Immediate Past-Chair for the ACC/AHA Task Force on Practice Guidelines and is the Co-Chair for the ACC Clinical Competency Committee. He was a member of the American Board of Internal Medicine and is a member of the Antithrombotic Trials Leadership and Steering (ATLAS) Group. Dr. Halperin is the co-founder of HWL, LLC.

Other planning committee member(s), speaker(s), activity director(s), author(s) or anyone in a position to control the content for this program report no financial interest or relationship* with any company(ies) or organizations whose product may be germane to the content of their presentations.

*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.

Provider Contact Information

Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center

Type:     Internet Activity (Enduring Material)
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