Question

An 86-year-old patient is admitted to hospital with a chest infection. She has chronic atrial fibrillation with previous cardioembolic left middle cerebral infarct 12 months ago. Her medications include dabigatran 110 mg BD. When medically stable her creatinine clearance is 20 mL/min. She functions independently at home, walks with a frame and had one fall 6 months ago. What is the best option for her long-term stroke prevention? A. Change to aspirin. B. Change to clopidogrel. C. Change to warfarin. D. Continue dabigatran. E. No antiplatelet or anticoagulation therapy."

Answer 1

The best long-term stroke prevention option for this elderly patient with chronic atrial fibrillation is to continue with dabigatran and anticoagulant therapy.

Step-by-step explanation:

The best option for long-term stroke prevention in this elderly patient with chronic atrial fibrillation and a previous cardioembolic left middle cerebral infarct would be to continue dabigatran. Dabigatran is an oral anticoagulant that helps prevent blood clots and reduce the risk of stroke in patients with atrial fibrillation. Atrial fibrillation increases the risk of blood clots forming in the heart, which can then travel to the brain and cause a stroke.

Changing to aspirin or clopidogrel, which are antiplatelet medications, may not provide sufficient protection against stroke in this patient. Aspirin and clopidogrel are usually considered as alternatives in patients who cannot tolerate or have contraindications to anticoagulation therapy.

Warfarin, another anticoagulant, is commonly used for stroke prevention in atrial fibrillation, but it requires regular blood monitoring and dose adjustments, making it less suitable for patients with impaired kidney function.

Learn more about Dabigatran