Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Metoprolol and aspirin
43%
3/7
Metoprolol and warfarin
Digoxin and aspirin
14%
1/7
Digoxin and warfarin
0%
0/7
Diltiazem and aspirin
Select Answer to see Preferred Response
Medical treatment for atrial fibrillation in stable patients centers around rate control and anticoagulation. This patient's CHADS2 score is 3 (age, hypertension, and diabetes), so in addition to rate control with a non-dihydropyridine calcium channel blocker or beta-blocker, warfarin is indicated for anticoagulation. The CHADS2 score is a clinical prediction rule for estimating the risk of stroke in patients with atrial fibrillation. The score dictates whether a patient should be treated with aspirin or warfarin anticoagulation therapy. One point is assigned for each of the following: congestive heart failure, blood pressure consistently above 140/90 mmHg, age greater than or equal to 75 years, and diabetes mellitus. Two points are added for prior stroke or TIA or thromboembolism. Patients with a score of zero can safely be treated with aspirin. A score of one indicates moderate risk and either aspirin or warfarin is acceptable. If CHADS2 is two or greater, the patient is high risk for embolic complications and warfarin is indicated. Guierrez and Blanchard review the diagnosis and treatment of atrial fibrillation and highlight the preference of rate control over rhythm control. The latter is considered if rate control cannot be obtained or if there are persistent symptoms despite adequate rate control. Anticoagulation therapy is needed as an additional measure to lower stroke risk. Warfarin is superior to aspirin or clopidogrel in preventing stroke, despite its narrow therapeutic range and increased risk of bleeding. Deedwania and Huang explain how dabigatran, a direct thrombin inhibitor, is now approved by the USFDA for stroke prophylaxis in nonvalvular atrial fibrillation. Recent studies have found it to be superior in preventing stroke and systemic embolism and to have a similar bleeding risk when compared with warfarin. Illustration A is a table of the CHADS2 scoring and the appropriate treatments for each risk category. Illustration B elucidates the mechanisms of action of some of the anticoagulants. Incorrect Answers: Answer 1 and 5: This patient’s CHADS2 score is 3, indicating that warfarin is preferred over aspirin as anticoagulation therapy. Answer 3 and 4: Digoxin can be used for rate control in atrial fibrillation patients with congestive heart failure, who are intolerant of beta blockers or non-dihydropyrididine calcium channel blockers, though one of the latter two would be the preferred.
5.0
(2)
Please Login to add comment