Atrial Fibrillation and Stroke | Ten Points to Remember

Lip GY, Lane DA.
Stroke Prevention in Atrial Fibrillation: A Systematic Review. JAMA 2015;313:1950-1962.

The following are 10 points to remember about this review on stroke prevention in atrial fibrillation (AF):

  1. The CHA2DS2-VASc risk stratification scheme is particularly helpful in identifying patients who are at low risk for stroke or thromboembolism (<1%/year) related to AF.
  2. Patients younger than 65 years of age with no additional risk factors for stroke (i.e., CHA2DS2-VASc = 0 for men, and 1 for women) are considered low risk for stroke or thromboembolism.
  3. Patients with at least one additional risk factor, as per the CHA2DS2-VASc score, should be offered an oral anticoagulant (OAC), either warfarin or a novel oral anticoagulant (NOAC).
  4. Inclusion of renal disease does not improve the predictive ability of the CHA2DS2-VASc score.
  5. A history of falls should not be considered an absolute contraindication to OAC with warfarin or a NOAC.
  6. In patients with a primary or secondary prevention indication for OAC, warfarin is associated with an absolute risk reduction of 2.7%/year (number needed to treat, 37) and 8.4%/year (number needed to treat, 12), respectively.
  7. The risk of major bleeding and intracranial hemorrhage in patients taking aspirin is similar to that in patients taking an OAC.
  8. The National Institute for Health and Care Excellence (NICE) guidelines recommend against using aspirin as monotherapy for stroke prevention in patients with AF.
  9. A European consensus group recommends that patients with AF who have recently undergone coronary stenting initially be treated with triple therapy (OAC, aspirin, and clopidogrel), followed by dual therapy (OAC, and aspirin or clopidogrel), and after 1 year, OAC alone.
  10. Left atrial appendage occlusion is an option for patients at high risk for stroke who are not thought to be good candidates for long-term oral anticoagulation.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Prevention, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Anticoagulants, Aspirin, Atrial Appendage, Atrial Fibrillation, Intracranial Hemorrhages, Numbers Needed To Treat, Primary Prevention, Risk Factors, Secondary Prevention, Stroke, Thromboembolism, Ticlopidine, Warfarin

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