D. Continue lifelong warfarin – Explanation
Warfarin should be continued indefinitely as this is his second episode of atrial fibrillation and he has
risk factors for stroke (age, hypertension)
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This scoring system superceded the CHADS2score.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 | Age 65-74 years | 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
