Anticoagulate based on CHA2DS2 VASc score DOACs preferred

By rray, 25 January, 2024
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If stroke risk
If stroke risk 1 to 2 per year CHA2DS2 VASc 1 in men 2 in women anticoagulation is reasonable
If stroke risk 2 per year CHA2DS2 VASc 2 in men 3 in women anticoagulate
Aspirin alone or w clopidogrel not recommended as alternative to anticoagulation
If mitral stenosis or mech heart valve warfarin 1st line DOACs 1st line for other valve dz
If post bariatric surgery warfarin 1st line due to concerns about DOAC absorption
Consider drug interactions when prescribing warfarin and DOACs esp CYP3A4 and or p glycoprotein inhibitors or inducers May require altered dosing
DOAC options nbsp nbsp Direct thrombin inhibitor dabigatran nbsp nbsp Factor Xa inhibitors rivaroxaban apixaban edoxaban nbsp nbsp If liver dz Child Pugh Class B Avoid rivaroxaban
If using warfarin target INR 2 3 consistent vit K dietary intake and routine INR monitoring
If ACS or PCI DOAC antiplatelet preferred over warfarin If PCI d c aspirin early 1 4wk and continue DOAC P2Y12 inhibitor vs triple tx to reduce bleed risk
If 1y post PCI or CAD w o coronary revasc OAC monotherapy preferred over combo tx w aspirin P2Y12 inhibitors
If PAD anticoagulant monotherapy preferred over combo tx w aspirin P2Y12 inhibitors
If stage 3 or 4 CKD w elevated stroke risk prescribe warfarin or DOAC dose adjusted for CrCl
If ESRD CrCl
If pregnant DOACs not recommended Warfarin safe in all trimesters If warfarin dose 5 mg day use LMWH Stop anticoagulation 36h before planned delivery
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Anticoagulate based on <a href=https://online.epocrates.com/contextuallink/medCalc/AtrialFibCHADSVASc.htm?activeMedCalcName=CHADS-VASc+Score+for+Stroke+Risk+in+Arial+Fibrillation+%28CHA%5B2%5DS%5B2%5D-VASc%29><u>CHA<sub>2</sub>DS<sub>2</sub>-VASc score</u></a>. DOACs preferred.