PPRNet Practice Guidelines
Atrial Fibrillation
Practice guideline:
Anticoagulant therapy (anti-platelet
agent or warfarin) prescribed for patients with atrial fibrillation
Systematic reviews
have found that people with atrial fibrillation
(AF) at high risk of stroke and with no contraindications are likely to
benefit from anticoagulation. Anti-platelet agents are less effective than
warfarin and are associated with a lower bleeding risk, but are a reasonable
alternative if warfarin is contraindicated or if risk of ischemic stroke is low.
A 2000 Agency for Healthcare Research and Quality Evidence Report concluded that for every 1000 patients with AF treated with warfarin for 1 year, 30 strokes are prevented at the expense of 6 major bleeds (intracranial, retroperitoneal or drop in HgB > 2gm/dL). For every 1000 patients with AF treated with aspirin for 1 year, 12.5 strokes are prevented with no additional bleeds.
Reference:
AHRQ Evidence Report:
Management of New Onset Atrial Fibrillation.
Additional resources:
ACC/AHA
Guidelines for the Management of Patients with Atrial Fibrillation
