CASE STUDY 2 - Stroke and risk of bleeding

Question 1

What tools can be used to calculate the risk of stroke and bleeding

Answer 1

CHA₂DS₂-VASc Score for Atrial Fibrillation Stroke Risk
Orbit bleeding risk tool- for bleeding

Question 2

What should be given to patients with a high CHA₂DS₂-VASc Score to reduce the risk of having strokes ?

Answer 2

An anticoagulant should be prescribed to prevent the risk of blood clots which could lead to strokes/heart attacks

Such as Apixaban

Question 3

What is a DOAC

Answer 3

Direct oral anticoagulant such as Apixaban

Question 4

Advantages of a DOAC such as Apixaban rather than warfarin

Answer 4

1. Less risk of bleeding
2. Less drug-drug interaction
3. Rapid onset
4. Doses does not vary between patients
5. Safer and more effective
6. No need to monitor diet such as abounding consumption of high vitamin K foods such as green leafs, broccoli, kale etc
7. Renal function isn’t as much of a concern
8. No need for monitoring e.g INR and no need for dose to be titrated

Question 5

What are the advantages of warfarin rather than a DOAC such as Apixaban ?

Answer 5

• Easy to reverse effects with vitamin K

Question 6

What should patients take with them/carry around if they are on warfarin ?

Answer 6

Yellow Anticoagulation book

Question 7

If a patient is on warfarin and is about to go into surgery. Should you withhold their warfarin ?

Answer 7

Yes as this can increase the risks of bleeding

Question 8

If a patient has a high INR before surgery what should you do ?

Answer 8

High INR suggests that the patient has a high blood risk of bleeding.

Patient should be given vitamin K to reverse the effects before surgery