CHA2DS2 VASc score
CHA2DS2
My response to the patient’s request would begin with informing her that changing her medication to one of the coagulants her friend takes would necessitate assessing the risk for bleeding, among other effects likely to occur. Specifically, I would inform the patient that determining the bleeding risk would involve calculating the HAS-BLED score, facilitating determining modifiable risk factors. I would further tell her that there are different types of atrial fibrillation, the condition for which she is receiving current treatment (Wojszel et al. 2019). Due to these differences, patients have unique risk factors attributed to a possible stroke. Based on the patient’s age, changing her current treatment regimen would intensify the susceptibility to other comorbidities and ultimately mortality. Besides, the treatment regimen prepared for one patient may not be suitable for another individual or maybe a misfit for managing the disease and any other underlying conditions (Da Costa Bronchtein, 2020).
Patient Education
Indeed, the anticoagulation medication should be considered for any patient with a CHA2DS2 VASc of 2 or more, which in this case, the patient has a score of 6. However, the anticoagulant medication choice should consider factors such as the patient’s weight and the current stroke and bleeding risks. If the coagulant is deemed appropriate for the patient, it would be more convenient due to its rapid onset of action, lack of regular monitoring, and minimal drug interactions (Ekerstad, Karlsson, Söderqvist, & Karlson, 2018). The patient stated that she no longer drives and has difficulty obtaining rides to the lab. The appropriate coagulant’s identification and prescription would address these issues and allow the patient to recover while at home.
Nonetheless, the side effects associated with the change to anticoagulation medications include minimal exposure of the drug, short half-life, and reduced concentration at peak with weight increase, intensifying the risk for under-dosing (Wojszel et al. 2019). Besides, there is a risk of thromboembolic events and bleeding complications and renal impairment during excretion at the patient’s age. Additionally, anticoagulants, such as Warfarin, have been associated with drug interactions with various drugs and foods. Thus, their concurrent use should be thoroughly considered (Da Costa Bronchtein, 2020).
References
Da Costa Bronchtein, A. I. (2020). Challenges for anticoagulation in atrial fibrillation. International Journal of Cardiovascular Sciences. https://doi.org/10.36660/ijcs.20190003
Ekerstad, N., Karlsson, T., Söderqvist, S., & Karlson, B. W. (2018). Hospitalized frail elderly patients – atrial fibrillation, anticoagulation, and 12 months’ outcomes. Clinical Interventions in Aging, 13, 749-756. https://doi.org/10.2147/cia.s159373
Wojszel, Z. B., Kasiukiewicz, A., Swietek, M., Swietek, M. L., & Magnuszewski, L. (2019). CHA2DS2-vasc score can guide the screening of atrial fibrillation – cross-sectional study in a geriatric ward. Clinical Interventions in Aging, 14, 879-887. https://doi.org/10.2147/cia.s206976
