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JAMA Clinical Guidelines Synopsis |

Management of Anticoagulation in Patients With Atrial Fibrillation

Joshua D. Moss, MD1; Adam S. Cifu, MD1
[+] Author Affiliations
1Department of Medicine, University of Chicago, Chicago, Illinois
JAMA. 2015;314(3):291-292. doi:10.1001/jama.2015.3088.
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Extract

This JAMA Clinical Guidelines Synopsis article summarizes the evidence for management of anticoagulation therapy in patients with atrial fibrillation.

Box Section Ref ID

Guideline title 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (Section on Prevention of Thromboembolism)

Developers American College of Cardiology (ACC)/American Heart Association (AHA) in collaboration with the Society of Thoracic Surgeons

Release dates March 28, 2014 (online); December 2, 2014 (print)

Prior version August 15, 2006 (with focused updates January 4, 2011, and March 15, 2011)

Funding sources ACC, AHA

Target population All patients with atrial fibrillation (AF). This summary focuses on patients with nonvalvular AF.

Major recommendations

  • For nonvalvular AF that is paroxysmal, persistent, or permanent, oral anticoagulation is recommended for patients with prior stroke, transient ischemic attack, or a CHA2DS2-VASc score of 2 or greater (class I recommendation) using warfarin (level of evidence A) or a direct thrombin or factor Xa inhibitor (level of evidence B). Antithrombotic therapy should be managed the same way for atrial flutter (class I recommendation, level of evidence C). For patients with nonvalvular AF and a CHA2DS2-VASc score of 0, it is reasonable to omit antithrombotic therapy (class IIa recommendation, level of evidence B). For a CHA2DS2-VASc score of 1, treatment with an oral anticoagulant or aspirin may be considered.

  • In the setting of chronic kidney disease (CKD), warfarin should be used in the setting of a creatinine clearance less than 15 mL/min or hemodialysis (class IIa recommendation, level of evidence B); reduced doses of dabigatran, rivaroxaban, or apixaban may be considered for moderate to severe CKD (class IIb recommendation, level of evidence C). Dabigatran and rivaroxaban should not be used in patients with end-stage CKD (class III recommendation, no benefit).

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