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Answer 3
  1. Enteric-coated aspirin. Anticoagulation for AF/flutter is based on the patient’s CHADS2 score. This is calculated by assigning a numeric value to the patient’s risk factors for a thromboembolic event: 1 point is assigned for congestive heart failure, hypertension, age 75 years or older, and diabetes; and 2 points are assigned for a prior stroke or transient ischemic attack. The total score determines the patient’s annual risk of a thromboembolic event and should be weighed against the risk for bleeding with warfarin. This patient has atrial flutter with a CHADS2 score of 0. Therefore, this patient can be managed with aspirin alone rather than warfarin. Digoxin is not appropriate in an active individual with rate-controlled flutter and normal left ventricular function. The addition of ß-blockers or calcium channel blockers is unnecessary in a patient who is already rate-controlled. Clopidogrel has not been shown to be beneficial in preventing thromboembolic events in the setting of AF/flutter.

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