Treatment
AF and Intracoronary Stent (with or without recent ACS) ÎFor patients with AF at high risk of stroke (eg, CHADS2
≥ 2) during the
first month after placement of a bare-metal stent (BMS) or the first 3 to 6 months after placement of a drug-eluting stent (DES), the ACCP suggests triple therapy (eg, a VKA, aspirin, and clopidogrel) (2C). After this initial period of triple therapy, the ACCP suggests a VKA (INR 2.0-3.0) plus a single antiplatelet drug (2C). At 12 months after intracoronary stent placement, antithrombotic therapy is suggested as for patients with AF and stable CAD.
ÎFor patients with AF at low to intermediate risk of stroke (eg, CHADS2 ≤ 1)
during the first 12 months after placement of an intracoronary stent (bare metal or drug eluting), the ACCP suggests dual antiplatelet therapy (2C). At 12 months after intracoronary stent placement, antithrombotic therapy is suggested as for patients with AF and stable CAD.
AF and ACS Without Stent
ÎFor the first 12 months for patients with AF at intermediate to high risk of stroke (eg, CHADS2
≥ 1) who experience an ACS and do not undergo
intracoronary stent placement, the ACCP suggests a VKA (INR 2.0-3.0) plus single antiplatelet therapy (2C). After the first 12 months, antithrombotic therapy is suggested as for patients with AF and stable CAD.
ÎFor patients with AF at low risk of stroke (eg, CHADS2 = 0), the ACCP
suggests dual antiplatelet therapy (eg, aspirin and clopidogrel) (2C). After the first 12 months, antithrombotic therapy is suggested as for patients with AF and stable CAD.
AF With a Rhythm Control Strategy
ÎFor patients with AF being managed with a rhythm control strategy (pharmacologic or catheter ablation), the ACCP suggests that antithrombotic therapy decisions follow the general risk-based recommendations for patients with nonrheumatic AF, regardless of the apparent persistence of normal sinus rhythm (2C).
Atrial Flutter
ÎFor patients with atrial flutter, the ACCP suggests that antithrombotic therapy decisions follow the same risk-based recommendations as for AF.
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