A. Offer no treatment or low-dose aspirin. No treatment is the preferred option – Explanation
Young man with AF, no TIA or risk factors, no treatment is now preferred to aspirin
The European Society of Cardiology guidelines suggest that ‘no treatment is preferred to aspirin’ for
low risk patients such as this man.
Atrial fibrillation: anticoagulation
The European Society of Cardiology published updated guidelines on the management of atrial
fibrillation in 2012. They suggest using the CHA2DS2-VASc score to determine the most appropriate
anticoagulation strategy.
This scoring system superceded the CHADS2score.
| Condition | Points | |
|---|---|---|
| C | Congestive heart failure | 1 |
| H | Hypertension (or treated hypertension) | 1 |
| A2 | Age ≥ 75 years | 2 |
| D | Diabetes | 2 |
| S2 | Prior Stroke or TIA | 1 |
| V | disease (including ischaemic heart disease and peripheral arterial disease) | 1 |
| A | Age 65-74 years | 1 |
| S | Sex (female) | 1 |
The table below shows a suggested anticoagulation strategy* based on the score:
| Score | Anticoagulation |
|---|---|
| 0 | No treatment is preferred to aspirin |
| 1 |
anticoagulants preferred to aspirin; dabigatran is an alternative |
| 2 or more | Oral anticoagulants; dabigatran is an alternative |
*the wording in the guidelines (‘is preferred to’) can be slightly confusing. It basically means that, say
for a score of 0, whilst aspirin is an acceptable management option the weight of the clinical
evidence would support no treatment instead
