Occasionally, patients present to the ED with new onset, rate-controlled atrial fibrillation. It's an incidental finding. Do you have to anticoagulate these patients because of the risk for a stroke?
This installment of the Paucis Verbis (In a Few Words) e-card series reviews Anticoagulation for Atrial Fibrillation from the Cardiology Clinics series. The article goes over lots of literature about the risk of stroke. I find the CHADS2 scoring system and the 2006 AHA/ACC/ESC Guidelines most helpful.
Note: Patients with persistent and paroxysmal atrial fibrillation should be treated the same when it comes to deciding about anticoagulation. They have an equivalent risk of stroke.
Feel free to download this card and print on a 4'' x 6'' index card.
Michelle,
ReplyDeleteexcellent as always. have you considered putting your name and the blog name on these cards so folks will always know where they came from.
scott
Hi Scott:
ReplyDeleteI thought about it but there is not much real estate on these cards for a logo or website address. I suppose I'll have to rely on word of mouth for now. I'll label these cards eventually if I have enough to create an e-book. Thanks for looking out for me.
Yes for prescribing warfarin to patients with enlarged left atrium and/or increased chads2 score.
ReplyDeleteNo for dogmatic INR between 2 and 3 when age >75 : INR is safer and more stable between 1,7 and 2,4, with same efficacity.
Jabeau: I totally agree with you. These were the recommendations from the article though. I also think INR's between 1.5 and 2.5 are ideal.
ReplyDeleteThanks for this. This maybe late but would you comment on the use of dabigatran?
ReplyDeleteInteresting question, JD. I'm unfamiliar with actually prescribing dabigatran, a thrombin-inhibitor. It first was approved for use in Europe and only became US FDA approved late 2010 and only for non-valvular atrial fib for the prevention of stroke. The studies are really too early for me change from the current standard practice of prescribing warfarin. Why do you ask?
ReplyDeleteThanks. Oh, I was just listening to a lecture from Sanjay Arora about HIT (Heparin-Induced Thrombocytopenia) and he says about thrombin inhibitors as an option if one needs anticoagulation (since coumadin is also discouraged as long as platelet is abnormal).
ReplyDeleteSo, I really have no experience on it. Thanks again.
JD: I hadn't heard of Sanjay's talk on this. Interestingly, I just heard of a 11 min video on management of dabigatran's bleeding:
ReplyDeletehttp://www.hqmeded.com/node/166
Excellent card, but there is now a new scoring system: the CHA2DS2Vasc. (New ESC guidelines)
ReplyDeleteOh wow, seriously!? More letters to remember? Will check it out. Thanks!
ReplyDelete