51
6.3.1.1. Considerations in Managing Anticoagulants
COR LOE
Recommendations
1 C-LD 1. For patients with AF receiving DOACs, optimal management
of drug interactions is recommended for those receiving
concomitant therapy with interacting drugs, especially CYP
3A4 and/or p-glycoprotein inhibitors or inducers (see Table
13).
1 B-R 2. For patients with AF receiving warfarin,* a target INR
between 2 and 3 is recommended, as well as optimal
management of drug-drug interactions, consistency in vitamin
K dietary intake, and routine INR monitoring to improve
time in therapeutic range and to minimize risks of preventable
thromboembolism or major bleeding.
3: Harm B-NR 3. For patients with AF, nonevidence-based doses of DOACs
should be avoided to minimize risks of preventable
thromboembolism or major bleeding and to improve survival.
* Excludes patients with mechanical valves.
6.4.1. Oral Anticoagulation for Device-Detected Atrial High-
Rate Episodes Among Patients Without a Prior Diagnosis of AF
COR LOE
Recommendations
2a B-NR 1. For patients with a device-detected atrial high-rate episode
(AHRE) lasting ≥24 hours and with a CHA
2
DS
2
-VASc score
≥2 or equivalent stroke risk, it is reasonable to initiate oral
anticoagulation within a SDM framework that considers
episode duration and individual patient risk.
2b B-NR 2. For patients with a device-detected AHRE lasting between
5 minutes and 24 hours and with a CHA
2
DS
2
-VASc score
≥3 or equivalent stroke risk, it may be reasonable to initiate
anticoagulation within a SDM framework that considers
episode duration and individual patient risk.
3: No
benefit
B-NR 3. Patients with a device-detected AHRE lasting <5 minutes and
without another indication for oral anticoagulation should
not receive oral anticoagulation.
6.4. Silent AF and Stroke of Undetermined Cause
COR LOE
Recommendation
2a B-R 1. In patients with stroke or TIA of undetermined cause, initial
cardiac monitoring, and, if needed, extended monitoring
with an implantable loop recorder are reasonable to improve
detection of AF.
