A 52-year-old woman presented with an episode of weakness of the left side of
her face and left arm that resolved after 3 hours. She was otherwise well and
had no significant past medical history.
On examination, her blood pressure was 110/75 mmHg.
Investigations:
ECG atrial fibrillation with a rate of 110
beats/min
echocardiogram structurally normal heart
Treatment was started with atenolol and warfarin.
She underwent a successful DC cardioversion 4 weeks later.
How long should she continue with warfarin therapy?
A: 4 weeks
B: 6 months
C: 1 year
D: 3 years
E: lifelong
Correct answer: E
Explanation
This woman has a history of transient ischaemic attack which puts her at high
risk of recurrent embolic episodes even after a successful cardioversion. She
would score 3 on the CHA2DS2-VASc score and anticoagulation should be
considered lifelong following a discussion about stroke and bleeding risk.