Offer oral anticoagulation to patients with non-valvular atrial fibrillation at raised stroke risk (CHA2DS2-VASc of 2 or more in men, 3 or more in women), and prefer a direct oral anticoagulant over warfarin for most. Antiplatelet therapy is not a substitute for stroke prevention in AF.
Assess bleeding risk to correct modifiable factors, not to withhold anticoagulation: a high bleeding score alone rarely outweighs the stroke benefit. Check renal function before and during direct oral anticoagulant dosing, and reassess the stroke-risk score over time, since it rises with age and new comorbidity.
- Offer anticoagulation when CHA2DS2-VASc is 2 or more in men, 3 or more in women.
- Prefer a direct oral anticoagulant over warfarin for most non-valvular AF.
- Do not use antiplatelets as a substitute for anticoagulation in AF.
- Use bleeding scores to fix reversible risks, not to deny therapy.
Why it matters
Stroke prevention, not rhythm, is the AF intervention that most changes long-term outcomes.
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