Updated: Aug 12, 2020
JL is a 64 year old female who has newly-diagnosed atrial fibrillation. To assess her CHADS2 stroke risk, the pharmacist is reviewing her record. She has an allergy to sulfamethoxazole, and her medical conditions include congestive heart failure and dyslipidemia. Her current medications include candesartan, carvedilol and rosuvastatin. What is the best recommendation to manage her stroke risk?
a) Initiate apixaban. b) Initiate acetylsalicylic acid. c) Initiate ticagrelor and acetylsalicylic acid. d) She does not require prophylactic treatment at this time.
Answer is at the bottom of the page.
(A) is the correct answer.
CHADS2 refers to congestive heart failure, hypertension, age over 75, diabetes, stroke and transient ischemic attack. Together, these risk factors predict stroke occurence and presence of any one of these factors means that the patient should be on an anticoagulant. JL has a CHADS2 score of 1 because of her heart failure history and should be started on apixaban.
a) Correct answer
b) ASA is not as efficacious as apixaban for anticoagulation, however, it is recommended for patients with a history of coronary artery disease (ie. myocardial infarction)
c) The combination of ASA and tiacgrelor is usually used for myocardial infactions.
d) This patient has a CHADS2 score greater than 0, so she requires prophylactic therapy.
If you liked this PEBC-style question, you can get more questions by purchasing access to our PEBC Qualifying MCQ Plan.