Please select the option that best describes you:
For elderly patients (i.e. older than 80) with only one documented episode of paroxysmal atrial fibrillation following a stress event (such as acute illness/steroid administration) and a CHADsVASc score greater than 1, how would you counsel them on the risks/benefits of anticoagulation and subsequent monitoring for afib recurrence?
Answer from: at Academic Institution
This is a relatively common scenario for which there are no randomized trials to guide management. There is strong observational evidence that an isolated episode of atrial fibrillation (AF) in the setting of an acute trigger is a marker for increased risk of subsequent recurrence and for stroke. Bu...
Answer from: at Community Practice
Prevent the worst complication, CVA, therefore anticoagulation even if guidelines don’t support this patient’s personal situation.
Answer from: at Academic Institution
Study has shown recurrence of afib in 1 year follow up after a provoked event even the patient has already returned sinus rhythm. Will do DOAC unless contraindicated.
Answer from: at Academic Institution
Increased risk of recurrence. One-time provoked event. Monitor with loop record. Discuss the risks and benefits of AC with the patient, allowing for an informed decision.
Answer from: at Community Practice
I will initially a/c for 3 months (similar to after valve or CABG) and reassess at that time.
Less likely to do long-term A/C if the patient presents with severe pulmonary deterioration, which transiently increases R-sided pressure - especially PE, which resolves.
Anticoagulation
Careful observation
From a medicolegal perspective, I always say antic...
I certainly agree. The risk of recurrent Afib is h...
Thorough discussion favoring anticoagulation.
Detailed discussion. Start anticoagulation, if pat...
Some 80 years old at least has a CHADS-VASc of 2 w...
One cannot introduce age into the guidelines on yo...
There is risk involved with either choice. Certain...
This is a frequent occurrence, and yes, the answer...