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
