Treatment Nonrheumatic AF
ÎFor patients with AF, including those with paroxysmal AF, who are at low risk of stroke (eg, CHADS2
score = 0), the American College of Chest Physicians
(ACCP) suggests no therapy (2B). Other factors that may influence the choice are bleeding risk and other stroke risk factors, including age 65 to 74 years, female gender and vascular disease. For patients who do choose antithrombotic therapy, the ACCP suggests aspirin (75 mg to 325 mg once daily) (2B). The presence of multiple non-CHADS2 anticoagulation therapy.
risk factors may favor
ÎFor patients with AF, including those with paroxysmal AF, who are at intermediate risk of stroke (eg, CHADS2
score = 1), the ACCP recommends
oral anticoagulation rather than no therapy (1B). The ACCP suggests oral anticoagulation rather than aspirin (2B) or combination therapy with aspirin and clopidogrel (2B). Other factors that may influence the choice are bleeding risk and other stroke risk factors, including age 65 to 74 years, female gender and vascular disease. The presence of multiple non-CHADS2 risk factors may favor anticoagulation therapy. For patients who are unsuitable for or choose not to take an oral anticoagulant (for reasons other than concerns about major bleeding), the ACCP suggests combination therapy with aspirin and clopidogrel (2B).
ÎFor patients with AF, including those with paroxysmal AF, who are at high risk of stroke (eg, CHADS2
score ≥ 2), the ACCP recommends oral
anticoagulation (1B). For patients who are unsuitable for or choose not to take an oral anticoagulant (for reasons other than concerns about major bleeding), the ACCP recommends combination therapy with aspirin and clopidogrel (1B).
ÎFor patients with AF, including those with paroxysmal AF, for recommendations in favor of oral anticoagulation (excluding patients with mitral stenosis, stents and acute coronary syndrome [ACS]), the ACCP suggests dabigatran 150 mg twice daily (2B) rather than a vitamin K antagonist (VKA) (target international normalized ratio [INR] 2.0-3.0).
AF and Mitral Stenosis
ÎFor patients with AF and mitral stenosis, the ACCP recommends a VKA (target INR 2.0-3.0) (1B). For patients with AF and mitral stenosis who are unsuitable for or choose not to take a VKA (for reasons other than concerns about major bleeding), the ACCP recommends combination therapy with aspirin and clopidogrel (1B).
AF and Stable Conorary Artery Disease
ÎFor patients with AF and stable coronary artery disease (CAD) (eg, no ACS within the previous year) and who choose oral anticoagulation, the ACCP suggests a VKA alone (INR 2.0-3.0) rather than VKA + aspirin (2C).
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