Anticoagulation in Atrial Fibrillation
Posted by dkwinter

Source: Academic Life in Emergency Medicine

Anticoagulation in Atrial Fibrillation

Waldo AL. Cardiol Clin 2009; 27:125-35.

 

Atrial Fibrillation (AF) = 5x risk for CVA and increases with age

Stroke risk stratification for patients with AF:

  • Prior CVA or TIA
  • HTN
  • Age ≥ 75
  • CHF
  • Poor LV function
  • DM

CHADS2 stroke risk stratification scheme (Gage BF et al. JAMA 2001;285:2864–70.)

  • C = Congestive heart failure (1 pt)
  • H = Hypertension (1 pt)
  • A = Age ≥ 75 (1 pt)
  • D = DM (1 pt)
  • S2 = prior Stroke or TIA (2 pts)

 

 

 

Deciding whether to anticoagulate with ASA or Warfarin:

(AHA/ ACC/ European Soc of Cardiology 2006 revised guidelines

for antithrombotic therapy based on stroke risk)

 

Weak Risk Factors      Moderate Risk Factors                    High Risk Factors         

Female gender              Age > 75                                              Prior CVA, TIA, embolism

Age 65-74                        HTN                                                    Mitral stenosis

CAD                                 Heart failure                                       Mechanical heart valve

Thyrotoxicosis                LVEF ≤ 35%

                                         DM                                                                                                

Treatment                    Treatment                                           Treatment

ASA or Warfarin          ASA or Warfarin (1 risk factor)     Warfarin

                                        Warfarin (≥ 2 risk factors)

 

* Anticoagulation goal with Warfarin is INR 2-3

* If age < 60 years and zero risk factors: No anticoagulation b/c low risk for CVA