[anoop_1198]

A 60 year old man with past history of stroke presented to the ER with palpitations. On ECG there were features of AF. Which of the following will you prescribe to prevent recurrent episodes of AF?
A. Aspirin
B. Amiodarone

The book says aspirin, but I think aspirin would help prevent sequelae of AF and not recurrent episodes of AF, which Amiodarone would help in... Sumone shed some light on this..

 

[lee-usmle]

Yes

I agree with the way you are thinking.

They did not use the appropriate wording here. They should have said "How to prevent the sequelae of AF".

 

[logical66]

A 60 year old man with past history of stroke presented to the ER with palpitations. On ECG there were features of AF. Which of the following will you prescribe to prevent recurrent episodes of AF?
A. Aspirin
B. Amiodarone

The book says aspirin, but I think aspirin would help prevent sequelae of AF and not recurrent episodes of AF, which Amiodarone would help in... Sumone shed some light on this..

First of all, remember the pharmacodynamics and pharmacokinetics of both drugs: Aspirin used during acute AF can help in many ways and also prevent aggravation with embolism and sluggishness of BF through systemic circulation, reduce piretic effects that may elevate BP further, but at the same time may induce bleeding in patient who are prone to have platelet dysfunction.
Amiodarone, as potent as it is can also induce fibrosis, aggravate pulmonary FEV1/FEV ratio (fast) which may also trigger and elevate BP and tachycardia, therefore acute AF. If I am right, by what I remember I read in harisson Principles of IM, the best shot is with aspirin, as it may reduce fever and help with COX/Cyclooxygenase effects and lower the pressure induced during AF.

 

[anoop_1198]

well that explains..but what would we give in acute AF....isn't it amiodarone...