New-onset AFib, CHA₂DS₂-VASc = 4. No echo yet. Should I start DOAC or warfarin? If DOAC, which one given his CrCl of 48?
- ECG.pdf
- Labs.pdf
New-onset AFib, CHA₂DS₂-VASc = 4. No echo yet. Should I start DOAC or warfarin? If DOAC, which one given his CrCl of 48?
Impression
High CHA₂DS₂-VASc, clear indication for anticoagulation.
Recommendation
Workup
Follow-up
4 weeks, or sooner if symptoms change.
Escalation flag
None — appropriate for primary management
Thanks. Patient is also on amiodarone for rate control. Any interaction concern with apixaban?
Amiodarone inhibits CYP3A4 and P-gp. Apixaban levels will increase about 20%. At CrCl 48 I'd still use 5mg BID but monitor for bleeding. If you want to be conservative, 2.5mg BID is reasonable given the dual hit.
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