Question
A 65-year-old female is being discharged from the hospital after an admission for a new-onset stroke. The patient was treated with intravenous alteplase one week ago. She has a past medical history of COPD, hypertension, diabetes, and atrial fibrillation. The patient’s weight is 86 kg, her creatinine clearance is 56 mL/min, ALT 19 U/L, AST 29 U/L, and albumin is 4 gm/dL. What is the patient’s CHA2DS2-VASc risk stratification score?
| A. |
CHA2DS2-VASc score of 2
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| B. |
CHA2DS2-VASc score of 3
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| C. |
CHA2DS2-VASc score of 4
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| D. |
CHA2DS2-VASc score of 6
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Show Answer
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Correct Answer � D
Explanation
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Ans. d
• The risk versus benefit for assessment of initiating anticoagulation can be calculated by using validated calculations, such as CHA2DS2-VASc for stroke risk, and HAS-BLED for bleeding risk.
• The recommendation is to initiate oral anticoagulation if the CHA2DS2-VASc stratification score is 2 or greater.
• CHA2DS2-VASc score stands for: congestive heart failure, hypertension, age greater than 75 (2 points), diabetes mellitus, stroke history, vascular disease, age 65-74 (1 point), and female gender. One point is given if any of these categories are present, except for age over 75, where two points are given.
• CHA2DS2-VASc evaluates ischemic stroke risk in patients with atrial fibrillation. This patient has a history of hypertension, diabetes mellitus, stroke history, age of 65, and is female, giving her a total score of 6.
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