A 72-year-old female presents with persistent atrial fibrillation. Her past medical history includes hypertension, diabetes mellitus, ischemic stroke 2 years ago, and congestive heart failure. What is her CHA2DS2-VASc score, and what is the recommended thromboprophylaxis?
Answer and explanation
Correct answer: C. Score 7; Oral anticoagulation (DOAC or Warfarin)
- Step 1: Count the CHA2DS2-VASc points: congestive heart failure +1, hypertension +1, age 65 to 74 +1, diabetes +1, prior stroke +2, female sex +1. Step 2. The total is 7. Step 3. A score of 2 or more in a patient with atrial fibrillation (and any prior stroke) calls for oral anticoagulation, with a DOAC preferred over warfarin in most patients. Answer: Score 7; Oral anticoagulation (DOAC or Warfarin). Why not the others: antiplatelet therapy alone (aspirin, clopidogrel or dual therapy) does not give adequate stroke protection at this score, and the lower scores miscount the risk factors.
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