Moderate risk (annual risk of CVA = 4%)

Moderate risk (annual risk of CVA = 4 %)

• Moderate risk is defined as either
  • age >=65 with no high risk factors*, or,
  • age <75 with hypertension, diabetes or vascular disease**
• if Moderate risk then
  • consider anticoagulation or aspirin
    

Notes:

• risk factors are not mutually exclusive, and are additive to each other in producing a composite risk. Since the incidence of stroke and thromboembolic events in patients with thyrotoxicosis appears similar to that in patients with other aetiologies of AF, antithrombotic treatments should be chosen based on the presence of validated stroke risk factors
• owing to lack of sufficient clear-cut evidence, treatment may be decided on an individual basis, and the physician must balance the risk and benefits of warfarin versus aspirin. As stroke risk factors are cumulative, warfarin may, for example, be used in the presence of two or more moderate stroke risk factors. Referral and echocardiography may help in cases of uncertainty
• *high risk factors
  • previous ischaemic stroke/TIA or thromboembolic event, or,
  • clinical evidence of valve disease, heart failure,
  • or impaired LV function on echocardiography
  • age >75 with hypertension, diabetes or vascular disease**
• **coronary artery disease or peripheral artery disease
  
  

Reference:

1. The Practitioner 1999; 243:746-51.
2. NICE (June 2006). Atrial Fibrillation