What is the role of anticoagulation prophylaxis in asymptomatic atrial fibrillation (AF)?

Updated: Dec 18, 2018
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Answer

Asymptomatic patients younger than 65 years with atrial fibrillation and none of the other risk factors are at a low risk and either should be treated with aspirin or should not be treated at all. Asymptomatic patients aged 65-74 years with atrial fibrillation and none of the other risk factors are at moderate risk and could be treated with warfarin (target INR 2.5, range 2-3) or aspirin 300 mg/day (not evidence based).

For asymptomatic patients older than 75 years with atrial fibrillation and none of the other risk factors, a lower target INR of 2 (range 1.6-2.5) may be accepted to decrease the risk of hemorrhage. However, this lower INR level has not been established, and some authorities disregard age and accept a higher INR target of 2.5.

For asymptomatic patients older than 80 years with atrial fibrillation and none of the other risk factors, aspirin (325 mg/d) might be preferable to long-term anticoagulation because it carries less risk of bleeding (not evidence based). An individual decision based on the patient's risk profile should be made.


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