A subset of patients with atrial fibrillation have a high risk of thromboembolism, which is evaluated using an internationally accepted scale (CHA2DS2-VASc score), and patients with a score of ≥2 have a high risk of thromboembolism. In addition to this, if you also have rheumatic mitral stenosis, you are at high risk of thromboembolism. Here is the scale for your reference, and whichever item matches your condition will be scored according to the score.
CHA2DS2-VASc Scale
Score
Your score
Chronic heart failure/left ventricular insufficiency
1
Hypertension
1
Age ≥ 75 years
2
Diabetes
1
Stroke/TIA/embolic event
2
Vascular disease
1
Age 65-74
1
Gender (female)
1
Total points
Maximum 9 points
Note: Vascular disease includes heart attacks, complex aortic plaques and peripheral arterial disease
Thromboembolism in patients with atrial fibrillation may include cerebral embolism, embolism of extremity arteries, and embolism of other internal organs, which may have serious consequences for the patient if they occur. Therefore, patients with a high risk of embolism, i.e., a CHA2DS2-VASc score of ≥2, require anticoagulation therapy.
When receiving anticoagulation therapy, the blood is less likely to clot, thus reducing the formation of clots (clots in the blood).
The most commonly used oral anticoagulant drug in clinical practice is warfarin. Warfarin has the advantages of long duration of action, ease of administration, low price, and relatively small and controllable side effects. However, many factors such as combination of drugs, food, disease status, individual differences, etc. can enhance or reduce the effect of warfarin, resulting in insufficient anticoagulation during treatment, leading to thrombosis, or excessive anticoagulation leading to bleeding tendency. The use of this drug needs to be under the guidance of a doctor and pharmacist. For more information, please refer to the Warfarin Medication Reference.
In addition to warfarin, other drugs currently available are dabigatranate and rivaroxaban, both of which have similar thromboprophylactic effects to warfarin and have a comparable or lesser chance of bleeding side effects than warfarin. It is easier to take these drugs because they do not require regular blood tests for coagulation. These two drugs are not currently covered by health insurance and will require you to pay for them yourself.
Aspirin and clopidogrel are two commonly used antiplatelet drugs that can also reduce the formation of blood clots. However, for your current disease, the use of these two drugs will not achieve the desired prevention of blood clots unless there are special circumstances or your doctor discusses the use of these drugs in place of warfarin due to your strong request.
If you also have coronary artery disease and require long-term aspirin and/or clopidogrel, you may need to take both aspirin/clopidogrel and one of the anticoagulants mentioned above, discuss with your doctor whether it is possible and necessary to take both anticoagulants.