Another Medscape article. After reading it, I am not sure what to think since different areas of the world disagree on what is the appropriate treatment.
medscape.com/viewarticle/84...
This one is interesting as well. "New AF Guideline Includes Four Key Changes" medscape.com/viewarticle/82...
The discussion seems to be are AF patients with no other risk element better off with or without anticoagulation. And that varies between consultants in the same part of the world and everywhere, as far as I can tell. And isn't this the discussion we have frequently on this forum? It is a moving target as more information accumulates and probably always will be and ALL of this is based on statistical probability. The future has to be in individualised medicine which WILL come, eventually!
The question is whether AF plus *one additional risk factor* warrants anticoagulation (i.e., a chad2vas2 score of 1 for men; 2 for women).
For men or women with one (or more) additional risk factor, these authors suggest that you should consider anticoagulation.
For men who have AF but no additional chad2vas2 risk factor (chad2vas2 score of zero), the recommendation is unambiguously no anticoagulation.
For women with no additional risk factor (chad2vas2 score of 1) ... hmmm ... that wasn't clear ... they didn't discuss this category very clearly, or maybe I missed it. My sense is this is a tricky category.
Fascinating to watch the development of alternatives to anti-coagulation, such as the evolving Watchman device. It's a great sign that research on AFib continues to grow.
Its a mine field. I just don't understand how everyone can be treated the same. there are some eighty year olds fitter than some sixty year olds and some sixty year old fitter than forty year olds and yet we all get the same advice and medication. Until we are all treated as individuals and our treatments are tailored to our needs I can't see how things will change.
I always struggled with research reviews as you have to be pretty damn clever to know whether the research is worth the paper it's printed on. I do find it interesting but you can always find a research paper to support your personal view if you look far enough.
I am one of the women with a score of 1. The consultant said no to anti-coagulants, but my GP said I should be on them. Indeed I am now. I went with the GP view, as he is more interested in my well-being, than the cardiologist seemed to be. For sure, a proper AF guideline is needed to ensure the best outcomes for each individual patient.
Very Interesting article
Rivaroxaban and Bleeding
