Would he qualify for oral anticoagulants

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Reference no: EM133511623

Case Study

A 76-year-old male patient presents to ED with cellulitis and feeling palpitations at times with shortness of breath. He has a history of diabetes mellitus, peripheral arterial disease with right toe amputation, and a history of recent cessation of smoking. His blood pressure is 150/88 HR 130 Rhythm- "New Onset" Atrial Fibrillation, RR 16 and Temperature of 100.5 F. He did not want to come to the hospital, his wife insisted since his cellulitis wounds started spreading and weeping. He seemed tired and 'cranky" lately, per his wife. He is treated with broad-spectrum IV antibiotics and moderate-rate fluid replacement. Cardiology was called to evaluate the A-Fib.

1. Using the CHA2DS2-VASc risk scoring system what would his score be?

2. Would he qualify for oral anticoagulants?

3. Would IV heparin infusion be considered in his case?

Oral Anticoagulants in A-Fib and Stroke Reduction

There are many oral anticoagulants available now, and each has its unique properties. If Coumadin (warfarin) is used, the INR goal is an average 2.5 (2-3); however, there are situations, especially in the over age 75 group, that a lower average goal of 2.0 INR is acceptable. Warfarin has an onset of 36-48 hours and can last in the system for 2-5 days, delaying any surgical procedures. Other oral anticoagulants for atrial fibrillation include Pradaxa (dabigatran), Xarelto (rivaroxban), Eliquis (apixaban), and Savaysa (edoxaban). Each has a unique half-life and reversal.

For those unable to take anticoagulants and who are at risk for atrial thrombus (which can form in the left atrial appendage due to reduced contractility during atrial fibrillation), a newer procedure has been developed called "Watchman." In this procedure, a tent-like device is placed in the LA appendage to seal it off. "In nonvalvular atrial fibrillation, 90% of stroke-causing clots come from the left atrial appendage" (5). The outpouching of the sac is seen protruding from the left atrium in the diagram below (5).

Conclusion

Many patients with atrial fibrillation, whether chronic or acute, will have risk factors for stroke. The clinical team's responsibility is to assess the risk of A-fib and stroke, then educate patients to assist in making decisions regarding stroke prevention. The risk of stroke from atrial fibrillation is a real concern as our population ages, and we have increasing amounts of patients diagnosed with A-fib and stroke. For patients presenting with ischemic stroke, the causal factors must be investigated to prevent stroke reoccurrence, which may include proper

Reference no: EM133511623

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