Practical Recommendations for Anticoagulation in Patients With Atrial Fibrillation - PubMed
5 hours ago
- #Atrial Fibrillation
- #Anticoagulation
- #Stroke Prevention
- Oral anticoagulation (OAC) is essential in atrial fibrillation (AF) to reduce stroke and mortality, with DOACs preferred over VKAs due to lower intracranial bleeding risk.
- OAC is recommended when stroke risk exceeds 1%-2% annually (typically CHA2DS2-VA ≥1), including in device-detected AF, with benefits increasing with additional risk factors.
- Modifiable bleeding risk factors (e.g., antiplatelet therapy, uncontrolled hypertension) should be regularly assessed and managed, as few absolute contraindications to OAC exist.
- Lifelong OAC is standard, but discontinuation may be considered after successful catheter ablation or left atrial appendage closure, pending further evidence.
- Integrated AF management includes periodic reassessment of adherence, thrombotic/bleeding risks, and co-medications, alongside risk factor control and dynamic patient-centered care.
- Special considerations apply for OAC in settings like cardioversion, surgery, elderly patients, and pregnancy, with VKAs preferred for mechanical valves or specific conditions.