assessing stroke risk in AF Flashcards
why do pt need to be assessed for their risk of stroke
AF can lead to complications e.g. stroke because the blood doesn’t fully eject, leading to clot
- Heart valve does not empty as it should
- Therefore the blood stays there and clots
all pt need to be assessed for their risk of stroke and the need for thromboprophylaxis; this needs to be balanced with
the pt risk of bleeding
stroke risk is assessed using
CHA2DS2-VASc risk tool
bleeding risk is assessed using
ORBIT tool
Risk factors for stroke taken into account by CHA2DS2-VASc
congestive heart failure (1)
hypertension (1)
age 75+ (2)
diabetes (1)
stroke/tia (2)
vascular disease (1)
age 65-74 (1)
female (1)
Anticoagulation should be offered for stroke prevention to all patients with a CHA2DS2-VASc score of ….
2 or above, and be considered in men with a score of 1
who will not need anticoagulation
CHA2DS2-VASc score of 0 for men or 1 for women
how often do scores need reviewing for people who require anticoagulation
at least annually
patients with a very low risk of stroke (CHA2DS2-VASc score of 0 for men or 1 for women) do not require anticoagulation for stroke prevention, but should have their stroke risk reviewed when…
they reach 65 years of age, or, at any age, if they develop diabetes, heart failure, peripheral arterial disease, coronary heart disease, stroke, TIA, or systemic thromboembolism.
For those not taking an anticoagulant because of bleeding risk or other factors,how often should you review risks
annually
Oral anticoagulation with …… is recommended in non-valvular atrial fibrillation.
DOAC such as apixaban, dabigatran etexilate, edoxaban, or rivaroxaban.
if CI or unsuitable, vit K antagonist e.g. warfarin
If anticoagulant treatment is contra-indicated or not tolerated,…… can be considered.
left atrial appendage occlusion
