Diagnosis
Key Points
Figure 1. Patterns of Atrial Fibrillation
Atrial fibrillation
Atrial flutter
Treatment
����Warfarin (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.
����The safety and efficacy of combining dabigatran, rivaroxaban, or apixaban
with an antiplatelet agent have not been established (IIb-C).
Aspirin, Clopidogrel & Warfarin
����Adjusted-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).
����Antiplatelet 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).
����For 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).
