Decreasing embolic risk from atrial fibrillation: aspirin, coumadin or nothing?

The decision to start a patient with chronic or paroxysmal atrial fibrillation on aspirin, coumadin or nothing is dependent on their thromboembolic risk. A commonly used risk stratification model is the CHADS2 score:

• 1 pt Congestive heart failure (any history)

• 1 pt Hypertension (prior history)

• 1 pt Age > or = 75

• 1 pt Diabetes mellitus

• 2 pt Secondary prevention in pts w/ prior ischemic stroke or TIA

If 0 points, manage with aspirin.

If > or = 3 points, manage with warfarin

If 1 or 2 points, management is variable. If patient's 2 points are from prior ischemic stroke or TIA consider warfarin. Also, consider patient preference/fall risk.

Arnsdorf, M MD, et al. "Overview of the presentation and management of atrial fibrillation." Up to Date. 25 May 2008.