Ameriška in evropska priporočila za uvedbo antikoagulacijskega zdravljenja

Ameriška: Antikoagulantno zdravljenje je priporočljivo pri bolnikih z atrijsko fibrilacijo, ki nimajo okvarjenih zaklopk, in so že doživeli ishemično možgansko kap, prehodno možgansko kap (TIA) ali na CHA2DS2-VASc lestvici dosežejo 2 točki ali več.

Evropska: Antikoagulantno zdravljenje je priporočljivo pri bolnikih z atrijsko fibrilacijo, ki  na CHADS2 lestvici dosežejo 2 točki ali več.

Ameriška: For patients with nonvalvular AF with prior stroke, transient ischemic attack (TIA), or a CHA2DS2-VASc score of 2 or greater, oral anticoagulants are recommended. Options include: warfarin (INR 2.0 to 3.0) (68-70) (Level of Evidence: A), dabigatran (74) (Level of Evidence: B), rivaroxaban (75) (Level of Evidence: B), or apixaban (76). (Level of Evidence: B)

For patients with nonvalvular AF and a CHA2DS2-VASc score of 0, it is reasonable to omit antithrombotic therapy (80, 81). (Level of Evidence: B)

For patients with nonvalvular AF and a CHA2DS2-VASc score of 1, no antithrombotic therapy or treatment with an oral anticoagulant or aspirin may be considered. (Level of Evidence: C)

Evropska: In patients with a CHADS2 score of 0–1, or where a more detailed stroke risk assessment is indicated, it is recommended to use a more comprehensive risk factor-based approach, incorporating other risk factors for thrombo-embolism. This risk factor-based approach can also be expressed as a point-based scoring system, the CHA2DS2-VASc score.

CHA2DS2-VASc (od 0 do 9 točk)

Bolnik
ima diagnosticirano srčno popuščanje 1
ima hipertenzijo 1
je star 75 let ali več* 2
ima sladkorno bolezen 1
je prebolel možgansko kap ali tranzitorni ishemični napad ali trombembolijo 2
ima srčno-žilno bolezen (prebolel infarkt, periferna arterijska bolezen, aortni plak) 1
starost od 65 do 74 let* 1
je ženska 1

 

CHA2DS2-VASc Replaces CHADS2

To estimate the risk of stroke in patients with nonvalvular AF, the guideline recommends replacing the CHADS2 score with the more comprehensive CHA2DS2-VASc score, whereby one point is given each for CHF, hypertension, diabetes, vascular disease (prior MI, PAD, aortic plaque), age 65 to 74, and sex category (female), and two points each for aged 75 or older and prior stroke/transient ischemic attack (TIA)/thromboembolism.

CHADS2 (od 0 do 6 točk)

Bolnik
ima diagnosticirano srčno popuščanje 1
ima hipertenzijo 1
je star 75 let ali več 1
ima sladkorno bolezen 1
je prebolel možgansko kap ali tranzitorni ishemični napad ali trombembolijo 2