4
Treatment
Table 9. Cigarette Smoking
Recommendations
COR LOE
Counseling, in combination with drug therapy using nicotine
replacement, bupropion, or varenicline, is recommended for active
smokers to assist in quitting smoking.
I A
Abstention from cigarette smoking is recommended for patients who
have never smoked on the basis of epidemiological studies showing a
consistent and overwhelming relationship between smoking and both
ischemic stroke and SAH.
I B
Community-wide or statewide bans on smoking in public spaces are
reasonable for reducing the risk of stroke and MI.
IIa B
Table 10. AF
Recommendations
COR LOE
For patients with valvular AF at high risk for stroke, defined as a
CHA
2
DS
2
-VASc score of ≥2 and acceptably low risk for hemorrhagic
complications, long-term oral anticoagulant therapy with warfarin at
a target INR of 2.0-3.0 is recommended.
I A
For patients with nonvalvular AF, a CHA
2
DS
2
-VASc score of ≥2,
and acceptably low risk for hemorrhagic complications, oral
anticoagulants are recommended. Options include warfarin (INR,
2.0-3.0),
I A
dabigatran, apixaban, and rivaroxaban. B
e selection of antithrombotic agent should be individualized on the basis of patient risk
factors (particularly risk for intracranial hemorrhage), cost, tolerability, patient preference,
potential for drug interactions, and other clinical characteristics, including the time that the
INR is in therapeutic range for patients taking warfarin.
Active screening for AF in the primary care setting in patients >65
years of age by pulse assessment followed by ECG as indicated can be
useful.
IIa B
For patients with nonvalvular AF and CHA
2
DS
2
-VASc score of 0, it
is reasonable to omit antithrombotic therapy.
IIa B
For patients with nonvalvular AF, a CHA
2
DS
2
-VASc score of 1,
and an acceptably low risk for hemorrhagic complication, no
antithrombotic therapy, anticoagulant therapy, or aspirin therapy may
be considered.
IIb C
e selection of antithrombotic agent should be individualized on the basis of patient risk
factors (particularly risk for intracranial hemorrhage), cost, tolerability, patient preference,
potential for drug interactions, and other clinical characteristics, including the time that the
INR is in the therapeutic range for patients taking warfarin.
Closure of the LAA may be considered for high-risk patients with
AF who are deemed unsuitable for anticoagulation if performed at a
center with low rates of periprocedural complications and the patient
can tolerate the risk of >45 days of postprocedural anticoagulation.
IIb B
