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Ask the doctors: Is it okay to discontinue warfarin?

Q. I recently developed atrial fibrillation, and I wonder whether I need to take an anticoagulant. I am 81 years old, active, and don’t really notice when I am in atrial fibrillation. I was taking my pulse every now and then and found it to be irregular. My doctor said I was going back and forth between a normal heart rhythm and atrial fibrillation. I am in normal (sinus) rhythm now, but he says I should be on warfarin because I have high blood pressure. What do you think?

A. Your physician’s recommendation of warfarin probably reflects his conclusion that the risks of treating you with warfarin are worthwhile, because this blood-thinning drug can reduce your risk of a stroke. He may be using the CHADS2 scoring system, which is a simple way of estimating a person’s risk of a stroke. The letters in CHADS2 stand for congestive heart failure, hypertension, age 75 years or more, diabetes mellitus, and prior stroke or transient ischemic attack. The first four factors earn you one point, and the last one earns you two points.

In this scoring system, the fewer points you get, the better. Your history of hypertension and your age give you a CHADS2 score of 2, which implies a stroke risk of 3%–5%. For people with this risk and higher, we recommend warfarin therapy. For people with a CHADS2 score of 1, aspirin and warfarin are both reasonable options. For a CHADS 2 score of 0, no treatment or aspirin alone is reasonable.

Since your score is one for which we recommend warfarin, I would suggest you give warfarin a try.

— Thomas Lee, M.D. and Richard Lee, M.D.
Co-Editors in Chief, Harvard Heart Letter

Posted by: Dr.Health

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