Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |AF - General |AF and Anticoagulation |AF and Rate Control |AF and Rhythm Control and Cardioversion |AF ECG |DC cardioversion
In AF, anticoagulation decisions balance the risk of stroke (CHA₂DS₂-VASc) ⚡ against the risk of bleeding (HAS-BLED) 💉. NICE recommends anticoagulation for most patients with CHA₂DS₂-VASc ≥ 1 (men) or ≥ 2 (women).
Score | Estimated Yearly Stroke Risk (%) | Management |
---|---|---|
0 | 0% | No anticoagulation |
1 | ~1.3% | Consider anticoagulation (men); in women, if only risk is “female sex”, omit |
2 | ~2.2% | Oral anticoagulants recommended |
3 | ~3.2% | Oral anticoagulants recommended |
4 | ~4.0% | Oral anticoagulants recommended |
5 | ~6.7% | Oral anticoagulants recommended |
6 | ~9.8% | Oral anticoagulants recommended |
7 | ~9.6% | Oral anticoagulants recommended |
8 | ~6.7% | Oral anticoagulants recommended |
9 | ~15.2% | Oral anticoagulants recommended |
A score ≥3 = higher bleed risk (≈3.7 bleeds/100 patient-years). Not a contraindication, but a flag for caution, review and modifiable risk factor control.
Feature | Score |
---|---|
Hypertension (SBP >160 mmHg) | +1 |
Abnormal renal/liver function | +1 each |
Stroke history | +1 |
Bleeding history/anaemia | +1 |
Labile INRs (if on warfarin) | +1 |
Elderly >65 | +1 |
Drugs (antiplatelets/NSAIDs) or Alcohol | +1 each |
Drug | Mechanism | Dosing Notes | Reversal |
---|---|---|---|
Warfarin | Vitamin K antagonist | Target INR 2–3 (2.5–3.5 in high risk). Many food & drug interactions. | Vitamin K + PCC (Octaplex/Beriplex) |
Dabigatran | Direct thrombin inhibitor | Avoid if CrCl <30. Reduce dose in age >80 or renal impairment. | Praxbind (idarucizumab) |
Apixaban | Factor Xa inhibitor | Reduce dose if ≥80yrs, weight ≤60kg, or renal impairment. | PCC (Octaplex/Beriplex) |
Rivaroxaban | Factor Xa inhibitor | Once daily. Reduce if CrCl 15–49. Avoid if <15. | PCC |
Edoxaban | Factor Xa inhibitor | Reduce in renal impairment or weight ≤60kg. Avoid if ESRD/dialysis. | PCC |