Can you explain stroke management including the primary/sec prvention CHADS2 score use in patients with lone afib and patients without afib. I listened to archers and followed Dr.Red's notes, which is real good. But I am not clear on this subject. Also TIA alone. It would be a great help.
Thanks.
bensha, sure
let us discuss afib:
1. Primary prevention of stroke means we want to prevent first episode of stroke in an at-risk patient who NEVER HAD A STROKE.
Secondary prevention means we want to prevent further or recurrent strokes in a patient with a history of CVA already.
2. One of the primary prevention strategies is using aspirin or warfarin in a patient who has risk factors for stroke. Other primary prevention strategies are lifestyle modifications, smoking cessation, hypertension control etc
Primary prevention of stroke in atrial fibrillation: the primary prevention strategy here depends on what is the risk of having a stroke in a patient with Afib. If Afib is the only risk factor and no other risk factors for stroke (chads2) then such afib is called "LONE AFIB" for prevention purposes.
In lone afib, aspirin is enough for stroke prevention
CHADS2 criteria:
Congestive heart failure (any history) 1 point
Hypertension (prior history) 1 point
Age ≥75 years 1 point
Diabetes mellitus 1 point
Previous TIA or CVA - 1 point
So now decision making and options:
Afib + CHADS2 score zero = Aspirin alone or no anti-thrombotic therapy
Afib + CHADS2 score one = Aspirin alone or coumadin
Afib + CHADS2 score two or more = Coumadin preferred
if patient has any of CHADS2 score
small correcton....2 points for TIA OR CVA
sorry rocky28 , yes it is 2 points for cva or tia. thx