Treatment
����For patients with ischemic stroke or TIA with paroxysmal (intermittent)
or permanent AF, anticoagulation with a vitamin K antagonist (target INR ���
2.5; range ��� 2.0-3.0) is recommended (I-A).
����For patients unable to take oral anticoagulants, aspirin alone (I-A) is
recommended. The combination of clopidogrel plus aspirin carries a risk
of bleeding similar to that of warfarin and therefore is NOT recommended
for patients with a hemorrhagic contraindication to warfarin (III-B).
Dabigatran
����Dabigatran is useful as an alternative to warfarin for the prevention of
stroke and systemic thromboembolism in patients with paroxysmal to
permanent AF and risk factors for stroke or systemic embolization who
do not have a prosthetic heart valve or hemodynamically significant valve
disease, severe renal failure (CrCl <15 mL/min), or advanced liver disease
(impaired baseline clotting function) (I-B).
����Dabigatran 150 mg twice daily is an efficacious alternative to warfarin for
the prevention of first and recurrent stroke in patients with nonvalvular AF
and at least one additional risk factor who have CrCl >30 mL/min (I-B).
����On the basis of pharmacokinetic data, the use of dabigatran 75 mg twice
daily in patients with AF and at least one additional risk factor who have
a low CrCl (15-30 mL/min) may be considered, but its safety and efficacy
have not been established (IIb-C).
����Because there are no data to support the use of dabigatran in patients with
more severe renal failure, dabigatran is NOT recommended in patients
with a CrCl <15 mL/min (III-C).
Apixaban
����Apixaban 5 mg twice daily is an efficacious alternative to aspirin in
patients with nonvalvular AF deemed unsuitable for vitamin K antagonist
therapy who have at least one additional risk factor and no more than one
of the following characteristics: Age ���80 years, weight ���60 kg, or serum
creatinine ���1.5 mg/dL (I-B).
����Although its safety and efficacy have not been established, apixaban
2.5 mg twice daily may be considered as an alternative to aspirin in
patients with nonvalvular AF deemed unsuitable for vitamin K antagonist
therapy who have at least 1 additional risk factor and ���2 of the following
criteria: Age ���80 years, weight ���60 kg, or serum creatinine ���1.5 mg/dL
(IIb-C).
����Apixaban 5 mg twice daily is a relatively safe and efficacious alternative to
warfarin in patients with nonvalvular AF deemed appropriate for vitamin K
antagonist therapy who have at least one additional risk factor and no more
than one of the following characteristics: Age ���80 years, weight ���60 kg, or
serum creatinine ���1.5 mg/dL (I-B).
