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Wednesday, September 16, 2009

More on Afib and warfarin

In my previous blog, I discussed some of the risk factors for stroke in patients with atrial fibrillation (AF).

Another way physicians assess a patient's risk of stroke with AF is to calculate a patient's CHADS score.

CHADS is a mneumonic:

1 - Congestive Heart Failure (1 point)
2 - Hypertension (1 point)
3 - Age over 75 years (1 point)
4 - Diabetes Mellitus (1 point)
5- Stroke or TIA history (2 points)

(Mitral Stenosis or prosthetic heart valve carry similar risk and also indicate Warfarin)

1. Patients with CHADS Score >2 (CVA risk >5% per year): should be on warfarin with goal INR 2.0 to 3.0

2. Patients with CHADS Score >1 (CVA risk >4% per year): could be on warfarin or aspirin

3. Patients with CHADS Score 0: can be maintained on aspirin 81 to 325 mg daily

All of this should be discussed completely with your physician. All patients should have a complete understanding of their risk of stroke and their candidacy for aspirin or coumadin.

In the not to distant future, a new class of medications (factor 10a inhibitors) will be available and will hopefully replace warfarin with improved safety and similar efficacy.

Gage (2004) Circulation 110:2287

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