B. Warfarin, target INR 2-3 – Explanation
The CHA2DS2-VASc for this patient is 3 – 2 for the transient ischaemic attack and 1 for being female.
She should therefore be offered anticoagulation with warfarin.
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This scoring system superceded the CHADS2score.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 | 1 |
| S2 | Prior Stroke or TIA | 2 |
| V | Vascular 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 | Oral 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
