Stroke Risk Assessment in a Patient With Atrial Fibrillation

A 74-year-old female patient with newly diagnosed paroxysmal atrial fibrillation (AF) was managed by her general practitioner.

Known history of peripheral artery disease.
No hypertension, diabetes, heart failure, angina or prior myocardial infarction.
Normal echocardiogram.

General practitioner classed the patient as 'low risk' and started patient on aspirin only.

Three months later the patient had a left sided stroke. Oral anticoagulation was started with adjusted dose warfarin (target INR 2-3). She made a good recovery post-stroke.

Six months later she was admitted with chest pain and dynamic ECG changes in the anterolateral leads, with positive troponin. A non-ST elevation myocardial infarction was diagnosed. Coronary angiography was undertaken, and a drug eluting stent deployed in the mid segment of the left anterior descending artery.

Following the presentation with the non-ST elevation myocardial infarction, and angioplasty/stent, her subsequent antithrombotic therapy should be as follows:

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