Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine (Pocket Notebook) Fifth Edition

If you purchased a copy of Sabatine: Pocket Medicine 5e, ISBN 978-1-4511-8237-8, please make note of the following important correction on page 1-36:

Oral anticoagulation (Chest 2012;141:e531S; EHJ 2012;33:2719; Circ 2013;127:1916)

· All valvular AF as stroke risk very high

· Nonvalv. AF: stroke risk ~4.5%/y; anticoag ® 68% ¯ stroke; use a risk score to guide Rx:

CHADS2: CHF (1 point), HTN (1), Age ≥75 y (1), DM (1), prior Stroke/TIA (2)

CHA2DS2-VASc: adds 65–74 y (1) ≥75 y (2), vasc dis. [MI, Ao plaque, or PAD (1)]; ? (1)

score ³2 ® anticoag; score 1 ® consider anticoag or ASA (? latter reasonable if risk factor age 65-74 y, vasc dis. or ?); antithrombotic Rx even if rhythm control [SCORE CORRECTED]

· Rx options: factor Xa or direct thrombin inhib (non-valv only; no monitoring required) or
warfarin (INR 2-3; w/ UFH bridge if high risk of stroke); if Pt refuses anticoag, consider

ASA + clopi or, even less effective, ASA alone (NEJM 2009;360:2066)