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Prevention of Stroke in Nonvalvular Atrial Fibrillation

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Diagnosis Key Points Figure 1. Patterns of Atrial Fibrillation Atrial fibrillation Atrial flutter Treatment ÎÎWarfarin (I-A), dabigatran (I-B), apixaban (I-B), and rivaroxaban (IIa-B) are all indicated for the prevention of first and recurrent stroke in patients with nonvalvular AF. The selection of an antithrombotic agent should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in INR therapeutic range if the patient has been taking warfarin. ÎÎThe safety and efficacy of combining dabigatran, rivaroxaban, or apixaban with an antiplatelet agent have not been established (IIb-C). Aspirin, Clopidogrel & Warfarin ÎÎAdjusted-dose warfarin (target INR – 2.0-3.0) is recommended for all patients with nonvalvular AF deemed to be at high risk and many deemed to be at moderate risk for stroke who can receive it safely (I-A). ÎÎAntiplatelet therapy with aspirin is recommended for low-risk and some moderate-risk patients with AF on the basis of patient preference, estimated bleeding risk if anticoagulated, and access to high-quality anticoagulation monitoring (I-A). ÎÎFor high-risk patients with AF deemed unsuitable for anticoagulation, dualantiplatelet therapy with clopidogrel and aspirin offers more protection against stroke than aspirin alone, but with an increased risk of major bleeding, and might be reasonable (IIb-B).

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