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Atrial Fibrillation

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44 Management 6.2. Risk-Based Selection of Oral Anticoagulation: Balancing Risks and Benefits COR LOE Recommendations 1 B-R 1. In patients diagnosed with AF who have an estimated annual risk of stroke or thromboembolic events ≥2%, selection of therapy to reduce the risk of stroke should be based on the risk of thromboembolism, regardless of whether the AF pattern is paroxysmal, persistent, long-standing persistent, or permanent. 1 B-NR 2. In patients with AF at risk for stroke, reevaluation of the need for and choice of stroke risk reduction therapy at periodic intervals is recommended to reassess stroke and bleeding risk, net clinical benefit, and proper dosing. 6.3.1. Antithrombotic Therapy COR LOE Recommendations 1 A 1. For patients with AF and an estimated annual thromboembolic risk of ≥2%/year (eg, CHA 2 DS 2 -VASc score of ≥2 in men and ≥3 in women), anticoagulation is recommended to prevent stroke and systemic thromboembolism. 1 A 2. In patients with AF who do not have a history of moderate to severe rheumatic mitral stenosis or a mechanical heart valve, and who are candidates for anticoagulation, direct oral anticoagulants (DOACs) are recommended over warfarin to reduce the risk of mortality, stroke, systemic embolism, and intracranial hemorrhage (ICH). 2a A 3. For patients with AF and an estimated annual thromboembolic risk of ≥1% but <2%/year (equivalent to CHA 2 DS 2 -VASc score of 1 in men and 2 in women), anticoagulation is reasonable to prevent stroke and systemic thromboembolism. 3: Harm B-R 4. In patients with AF who are candidates for anticoagulation and without an indication for antiplatelet therapy (APT), aspirin either alone or in combination with clopidogrel as an alternative to anticoagulation is not recommended to reduce stroke risk. 3: No benefit B-NR 5. In patients with AF without risk factors for stroke, aspirin monotherapy for prevention of thromboembolic events is of no benefit. 6.3. Oral Anticoagulants

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