9
Table 4. Risk-Based Antithrombotic Therapy (cont'd)
Recommendations COR LOE
For patients with atrial flutter, antithrombotic therapy
is recommended according to the same risk profile used
for AF.
I C
For patients with nonvalvular AF and a CHA
2
DS
2
-VASc
score of 0, it is reasonable to omit antithrombotic therapy.
IIa B
For patients with nonvalvular AF with a CHA
2
DS
2
-VASc
score of ≥2 and who have endstage CKD (CrCl <15 mL/min)
or are on hemodialysis, it is reasonable to prescribe warfarin
(INR 2.0-3.0) for oral anticoagulation.
IIa B
For patients with nonvalvular AF and a CHA
2
DS
2
-VASc
score of 1, no antithrombotic therapy or treatment with an
oral anticoagulant or aspirin may be considered.
IIb C
For patients with nonvalvular AF and moderate-to-severe
CKD with CHA
2
DS
2
-VASc scores of ≥2, treatment with
reduced doses of direct thrombin or factor Xa inhibitors
may be considered (e.g., dabigatran, rivaroxaban, or
apixaban), but safety and efficacy have not been established.
IIb C
In patients with AF undergoing percutaneous coronary
intervention,
a
bare-metal stents may be considered to
minimize the required duration of dual antiplatelet
therapy. Anticoagulation may be interrupted at the time of
the procedure to reduce the risk of bleeding at the site of
peripheral arterial puncture.
IIb C
Following coronary revascularization (percutaneous or
surgical) in patients with AF and a CHA
2
DS
2
-VASc score
≥2, it may be reasonable to use clopidogrel (75 mg QD)
concurrently with oral anticoagulants but without aspirin.
IIb B
e direct thrombin inhibitor dabigatran and the factor Xa
inhibitor rivaroxaban are NOT recommended in patients
with AF and end-stage CKD or on dialysis because of the
lack of evidence from clinical trials regarding the balance of
risks and benefits.
III: No
Benefit
C
e direct thrombin inhibitor dabigatran should NOT be
used in patients with AF and a mechanical heart valve.
III: Harm B
a
See the 2011 percutaneous coronary intervention guideline for type of stent and duration of dual
antiplatelet therapy recommendations. (Levine GN, et al. J Am Coll Cardiol. 2011;58:e44-122.)
Table 5. Cardiac Surgery—LAA Occlusion/Excision
Recommendation COR LOE
Surgical excision of the LAA may be considered in patients
undergoing cardiac surgery.
IIb C
