Should You Take an Anticoagulant for AF? — Applying the 4 questions

This study of nearly 1000 elderly AF patients found that the risk of major bleeding was not different between aspirin and warfarin. I, therefore, side more with the European guidelines. Aspirin confers significant bleeding with either no or minimal stroke prevention effects. 4. What happens if I do nothing? This is easy. For the patients above, who have two risk factors, the green faces depict what happens if they do nothing. The most likely scenario is that they will not have a stroke (approx 97%) and not have a bleed (98%). The North American AF treatment guidelines grade the strength of their recommendations. They give the strongest rating for shared decision-making surrounding the choice to take an anticoagulant drug or not. It’s up to you. ******* Four caveats: Caveat 1: One is that doctors think the stroke prevention/bleeding risk tradeoff noted above is a good one. You may quibble with it. You might say the 1.7% risk reduction in the probability of stroke is balanced by the 1.2% increased probability of a major bleed. What I explain to patients is that strokes are much worse than major bleeds. Bleeding is scary and to be avoided, but bleeding rarely leads to disability like strokes. Most patients who suffer bleeds leave the hospital the same person they were on admission. Strokes, on the other hand, can leave people without speech, thinking, swallowing or movement. Caveat 2: The numbers listed above vary. For higher risk patients (CHADSVASC >2) the risk of str...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs