A 68-year-old male with persistent non-valvular atrial fibrillation has hypertension and type 2 diabetes. What is his CHA2DS2-VASc score and indicated management?
Answer and explanation
Correct answer: A. Score 3; initiate oral anticoagulation
- Step 1: Calculate the CHA2DS2-VASc score: Age 65 to 74 scores 1 point, Hypertension scores 1 point, Diabetes scores 1 point, totaling 3 points.
- Step 2: For non-valvular atrial fibrillation in males with a score of 2 or higher, oral anticoagulation is strongly recommended to prevent ischemic stroke.
Answer
Score 3; initiate oral anticoagulation.
Why not the others: A score of 1 does not reflect the three established risk points in this patient. Antiplatelet therapy is significantly inferior to oral anticoagulation for cardioembolic stroke prevention in atrial fibrillation. Score 0 applies only when no risk factors are present.
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