sheeezooo
Forum Guru
Topics: 30
Posts: 343
|
56 y/o f atrial fibrillation.and asymptomatic.HR70/min.denies hypertention,diabetes,and congestive heart failure.no other past medical history..what is most appropriate management??
1.warfarin and clopidogrel
2.heparin followed by warfarin
3.low molecular wt heparin
4.aspirin(325mg) daily
5.warfarin to maintain an INRof 2 to 3
___________________
if u hold up your head with a smile on your face and are truely thankful,u are blessed because the majority can, but most do not..
|
| frank100
Forum Guru
Topics: 48
Posts: 586
|
2
|
| Sea_gull
Forum Elite
Topics: 32
Posts: 179
|
frank100 wrote:
2
I agree with you Frank ,basically pt has to be maintained on Warfarin but first the heparin should be started to prevent skin necrosis.Last choice also seems correct that INR must be maintained between 2-3 with warfarin.
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
___________________
The Key to Succeed is Patience.
|
| study_ing
Forum Fanatic
Topics: 180
Posts: 2,511
|
AGREED to 2 as well 
___________________
If you yourself are at peace, then there is at least some peace in the world.
|
| sheeezooo
Forum Guru
Topics: 30
Posts: 343
|
but the answer is 4
___________________
if u hold up your head with a smile on your face and are truely thankful,u are blessed because the majority can, but most do not..
|
| study_ing
Forum Fanatic
Topics: 180
Posts: 2,511
|
very intersting..i went and read this uppa nd here is what i found..
Lone AF--aspirin or no Rx
valvular AF--warfarin
___________________
If you yourself are at peace, then there is at least some peace in the world.
|
| study_ing
Forum Fanatic
Topics: 180
Posts: 2,511
|
non-valvular persistent or paroxysmal AF and one risk factor or more--warfarin
if age 65-74 and no other risk factors-->? aspirin
if pt not good candidate for warfarin ( hi risk of bleeding/falling)--> aspirin
___________________
If you yourself are at peace, then there is at least some peace in the world.
|
| frank100
Forum Guru
Topics: 48
Posts: 586
|
something extremely important must be missing from the history for (4) to be the answer. not even hemodinamicaly stable patients with afib, are left alone with aspirin!!
that would be elegant to post the whole question and the aswer as it is in the Qthing. because this is disturbing, intrigating!!! maybe, in medicine you never know, but this is....
|
| study_ing
Forum Fanatic
Topics: 180
Posts: 2,511
|
i just posted the above info directly off a 2004 text book.....
___________________
If you yourself are at peace, then there is at least some peace in the world.
|
| frank100
Forum Guru
Topics: 48
Posts: 586
|
yes, i did some research too....hmmm interesting
thanks sheezoooo!
|
| icemaiden
Forum Elite
Topics: 9
Posts: 117
|
I read this somewhere(dont remember the source now)and these are the recommendations regarding anticoagulation in the treatment of AF are
--Patients younger than 65 years with risk factors receive warfarin therapy with a goal INR of 2-3.
--Patients younger than 65 years with no risk factors receive ASA therapy or no treatment
--Patients older than 65 years receive warfarin therapy with a goal INR of 2-3.
--Patients older than 75 years with no risk factors receive ASA therapy
The risk factors are-prior stroke or transient ischemic attack, diabetes, hypertension, CAD, mitral stenosis, prosthetic valve, CHF, echocardiographic findings of an enlarged left atrium, and global LV dysfunction.
ice
|
| cbenitesch
Forum Senior
Topics: 10
Posts: 141
|
nice question!
|
| sheeezooo
Forum Guru
Topics: 30
Posts: 343
|
-the american college of chest physicians has established guidlines for anticoagulation in non rhumatic atrial fibrilltion.
-pt with risk factors for the formation of thrombi such as a previos stroke,transient ischemic attach,systemic thromboembolism,left ventricular dysfuntion,recent congestive heart failure,systemic hypertension,or diabetes should be placed on warfarin
-pts with no risk factors who are younger than 65 years are considered to be low risk and should take one aspirin daily.
aspirin is also suitable for pts with a contraindication to warfarin therapy.
the efficacy of other antiplatelet agents has not been proven in pts with atrial fibrillation.
___________________
if u hold up your head with a smile on your face and are truely thankful,u are blessed because the majority can, but most do not..
|
| study_ing
Forum Fanatic
Topics: 180
Posts: 2,511
|
God bless u sheezooo
great point..wud have loaded em all woth warfarin on my step otherwise!!
___________________
If you yourself are at peace, then there is at least some peace in the world.
|
| study_ing
Forum Fanatic
Topics: 180
Posts: 2,511
|
u mentioned something about rate..is that in any way significant apart from judging hemodynamic stabiltiy
___________________
If you yourself are at peace, then there is at least some peace in the world.
|
|
| |
| | | | | | | | | | | | | | | | |
