Do not offer aspirin monotherapy solely for stroke prevention to people with atrial fibrillation (1) Aspirin monotherapy is not associated with a lower risk of ischemic events, while significantly associated with a higher risk of bleeding events. Patients with AF are unlikely to benefit from aspirin monotherapy. (2)
Use a direct oral anticoagulant (DOAC) in preference to a vitamin K antagonist.
Anticoagulation based on the CHADS2 score
Score | Risk | Anticoagulation Therapy | Considerations |
0 | Low | Aspirin or no treatment | No antithrombotic therapy (or aspirin) |
1 | Moderate | Aspirin or Warfarin | Aspirin daily or raise INR to 2.0-3.0, depending on factors such as patient preference |
2 or greater | Moderate or High | Warfarin | Raise INR to 2.0-3.0, unless contraindicated (e.g. clinically significant GI bleeding, inability to obtain regular INR screening) |
To complement the CHADS2 score, by the inclusion of additional 'stroke risk modifier' risk factors, the CHA2DS2-VASc score has been proposed (1)
CHA2DS2-VASc score for stroke risk in atrial fibrillation
Feature | Score |
Congestive Heart Failure | 1 |
Hypertension | 1 |
Age >75 years | 2 |
Age between 65 and 74 years | 1 |
Stroke/TIA/TE | 2 |
Vascular disease (previous MI, peripheral arterial disease or aortic plaque) | 1 |
Diabetes mellitus | 1 |
Female | 1 |
Reference:
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