AAFP Guidelines Bundle

Atrial Fibrillation - Pharmacological Management

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Table 4. Oral Anticoagulants for Stroke Prevention in Patients with Atrial Fibrillation Medication (30-day supply) Dose a Benefits b Risks b Warfarin Varies (Titrated to INR) • Inexpensive • Reversal agent available • Can use in end-stage renal disease (CrCl <15) • Well studied • Bleeding • Contraindicated in pregnancy • Many potential food and drug interactions Apixaban 5 mg bid ↓ Stroke ↓ Major bleeding ↓ Intracranial hemorrhage ↓ All-cause mortality • No reversal agent • Caution with use in end- stage renal disease Dabigatran 150 mg bid ↓ Stroke ↓ Intracranial hemorrhage • Reversal agent available ↑ MI ↑ GI bleeding • Not approved for use in end-stage renal disease Edoxaban 60 mg daily ↓ Major bleeding ↓ Cardiovascular mortality • No reversal agent • Not approved for use in end-stage renal disease Rivaroxaban 20 mg daily ↓ Intracranial hemorrhage • Bleeding (similar to warfarin) • No reversal agent • Caution for use in end-stage renal disease a Dose of non-vitamin K antagonist oral anticoagulant (NOAC) should be adjusted for patients with renal insufficiency. b Benefits/risks of NOACs compared to warfarin. Table 5. Increased Risk of Major Bleeding with Dual Therapy Treatment Increased Risk (95% CI) Number Needed to Harm Warfarin + antiplatelet therapy HR 1.5 (1.22–1.86) 55 Dabigatran 150 mg + antiplatelet therapy HR 1.81 (1.46–2.24) 58 Dabigatran 110 mg + antiplatelet therapy HR 1.53 (1.21–1.92) 62

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