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 over 1 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. Which of the following is the appropriate long-term anticoagulation for this patient?
| A. |
Warfarin with heparin bridging with goal INR 2-3
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| B. |
Apixaban 5 mg twice daily with enoxaparin bridge
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| C. |
Apixaban 5 mg twice daily
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| D. |
Enoxaparin 80 mg twice daily
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Show Answer
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Correct Answer � C
Explanation
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Ans. c
• The use of oral anticoagulation (OAC) is currently strongly recommended as first-line therapy for the prevention of primary and secondary strokes in patients with atrial fibrillation.
• Patients with atrial fibrillation with moderate to high risk of thromboembolic events may benefit from long-term anticoagulation.
• Most studies have shown that using direct thrombin and factor Xa inhibitors, such as apixaban and rivaroxaban, may have less risk of intracranial hemorrhage than patients on warfarin.
• 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 OAC if the CHA2DS2-VASc stratification score is 2 or greater
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