Treatment
Table 3. Treatment Summary Condition
Nonrheumatic AF (2B)b
CHADS2 0
1 2
a Notes
Evidence Grade
Early Rx
2B No Rx OR long-term aspirin 75-325 mg/d
1B-2B
2B Oral anticoagulation (Suggest dabigatran over VKA). If unsuitable or not patient choice: aspirin + clopidogrel over aspirin
Stable CAD and AF
Mitral stenosis and AF
Intracoronary stent and AF
≥ 2 BMS 2C VKA (INR 2.0-3.0) 1B VKA (INR 2.0-3.0)
2C VKA therapy, aspirin, and clopidogrel x 1 mo
DES
2C VKA therapy, aspirin, and clopidogrel x 3-6 mo
≤ 1
Acute CAD and AF – no stent
Atrial flutter
Cardioversion of atrial flutter or AF
All
Elective > 48 h
Elective ≤ 48 h
Urgent 1B 2C 2C ≥ 1 0 2C
Aspirin + clopidogrel x 12 mo
2C VKA (INR 2.0-3.0) + aspirin OR clopidogrel x 12 mo
2C
Aspirin + clopidogrel x 12 mo
(Same as AF)
Before cardioversion: VKA (INR 2.0-3.0) x 3 wks
Before cardioversion: LMWH or UFH (full dose)
Aſter successful cardioversion: VKA (INR 2.0-3.0) x ≥ 4 wks
a Other factors that may influence the choice are bleeding risk and other stroke risk factors, including age 65 to 74 years and female gender, which have been more consistently validated, and vascular disease, which has been less well validated. The presence of multiple non-CHADS2 anticoagulation therapy.
risk factors may favor
b For AF with a rhythm control strategy, follow the risk-based recommendations for nonrheumatic AF, regardless of the apparent persistence of normal sinus rhythm.
4
Then: VKA (INR 2.0-3.0) + aspirin or clopidogrel At 1 yr: VKA (INR 2.0-3.0)
Then: VKA (INR 2.0-3.0) + aspirin or clopidogrel At 1 yr: VKA (INR 2.0-3.0)
At 1 yr: VKA (INR 2.0-3.0)
At 1 yr: VKA (INR 2.0-3.0)
At 1 yr: VKA (INR 2.0-3.0)
Subsequent Rx
