Monday, February 23, 2015

Study group discussion: To anticoagulate or to not anticoagulate

One quick review question:
So patient has new onset atrial fibrillation. Would you start the anticoagulation right away?

Its only after 48 hrs of onset, that too you have to rule out intra-atrial thrombus by trans esophageal endoscopy. If the thrombus is present, you give heparin.

Yeah when there is thrombus that's a must! But let's say no thrombus now what? 35 yrs old male.  Can we start  anticoagulants?

There is specific criteria. For assessment of thromboembolic risk. It's called CHADS2.

Oh yes, if the score is >=1 then you start it. One point each for CHF, HTN, age >75, diabetes and 2 points for prior stroke or TIA.

If patients have not been adequately anticoagulated and the AF is more than 24–48 h in duration, a transesophageal echocardiogram (TEE) can be performed to exclude the presence of a left atrial thrombus that might dislodge with the attempted restoration of sinus rhythm with either nonpharmacologic or pharmacologic therapy.

It can be a different scenario!
* In the case I was discussing above the AF resolved soon after metoprolol.

And in that case anticoagulation are started as prophylaxis. So would be oral warfarin or the LMWHs.

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