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  #1  
Old 10-22-2015
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Default Repeated USMLE Questions 135

A 75 year old man presents to his physician for a routine examination. He has a history of hypertension, hypercholesterolemia and osteoarthritis. He takes atenolol, simvastatin and ibuprofen as needed. His pulse is 76/min and irregular. Blood pressure is 130/74. Physical examination and imaging studies are normal except for asymptomatic atrial fibrillation.

What is the most appropriate next step in management of this patient?

A- Assurance and follow up in 3 months

B- Start aspirin

C- Start heparin

D- Start warfarin

E- Start low molecular weight heparin and warfarin

Answer
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Old 10-22-2015
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Quote:
Originally Posted by sohag100 View Post
a 75 year old man presents to his physician for a routine examination. He has a history of hypertension, hypercholesterolemia and osteoarthritis. He takes atenolol, simvastatin and ibuprofen as needed. His pulse is 76/min and irregular. Blood pressure is 130/74. Physical examination and imaging studies are normal except for asymptomatic atrial fibrillation.

What is the most appropriate next step in management of this patient?

A- assurance and follow up in 3 months

b- start aspirin

c- start heparin

d- start warfarin

e- start low molecular weight heparin and warfarin

answer
ddddddddddddd
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Old 10-24-2015
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E ? D- warfarin could transitory give hypercoagulable state ?
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Old 10-24-2015
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Default Small dose

The best dose for warfarin to start with is 5 mg daily and to keep close eye on INR.
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Old 10-24-2015
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Quote:
Originally Posted by shidox View Post
E ? D- warfarin could transitory give hypercoagulable state ?
You only need to give heparin before warfarin when a clot is suspected or present (DVT or PE)
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Old 10-24-2015
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Thanks, so D

Found:
Initiation of warfarin therapy has long been associated with the possibility of transient hypercoagulability from depletion of anticoagulant factors. This concern is often regarded as largely theoretical, and current atrial fibrillation (AF) guidelines do not recommend bridging therapy with heparin when starting warfarin for thromboembolism prophylaxis.
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Old 10-25-2015
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Default Nice

Exactly. Pretty much everyone with A-fib gets Warfarin alone. Know the Chads2Vasc score which is scored out of 9. 0 points no therapy. 1 point warfarin (preferred) or aspirin. 2 points or greater Warfarin alone. Also, to take it a step further in non valvular A-fib there are alternatives to Warfarin you can use. Look them up
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