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Ischemic strokes often occur due to atrial fibrillation (AF), one of the most common arrhythmias in patients. Scoring systems have been used for stroke prediction to determine antithrombotic therapy, mainly CHADS (congestive heart failure, hypertension, age ≥75 years, diabetes, and stroke), since 1996. This scale uses 0 to >2 to determine the need for anticoagulation. A zero score is low risk with no anticoagulation recommended, a score of one is moderate risk, anticoagulation or antiplatelet may be considered, and a score of two or higher is high risk requiring intervention (Aziz, Mills, & Newbury, 2019). 

In 2010 the CHA DS -VASc was developed to better identify patients at low risk and their need for anticoagulation by considering additional risk factors for stroke, including vascular disease, sex, and ages 65-75 (Aziz, Mills, & Newbury, 2019).

 

According to Sanders et al. (2018), several therapy considerations exist in a systematic review of stroke prevention in atrial fibrillation. Dabigatran was found to be superior in preventing stroke or systemic embolism. Apixaban has less risk for bleeding and was preferred over warfarin in preventing strokes or systemic embolism. Rivaroxaban may better prevent strokes or systemic embolism but may have a higher risk of major bleeding. Edoxaban is like warfarin in preventing strokes or systemic embolism but may have decreased risk for major bleeding or hemorrhagic stroke. They found that further studies were needed on individual Xa and thrombin inhibitors and oral anticoagulants.

 

References

 

Aziz, H., Mills, D., & Newbury J. (2019) Adherence to antithrombotic therapy guidelines and atrial fibrillation in a rural hospital: a clinical audit. Rural & Remote Health 19(1), 1-6. https://doi.org/10.22605/RRH4342

 

Sanders G. D., Lowenstern A., & Borre E., et al. (2018). Stroke prevention in patients with atrial fibrillation: a systematic review update. Agency for Healthcare Research and Quality, 214. 18(19)-EHC018-EF. https://doi.org/10.23970/AHRQEPCCER214.

SCIENCE
HEALTH SCIENCE
NURSING
NURS 6050