What is the efficacy of anticoagulation with warfarin to decrease stroke risk associated with atrial fibrillation (Afib) (AF)?

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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At least four large clinical trials have clearly demonstrated that anticoagulation with warfarin decreases the risk of stroke by 50-80%. In relatively recent trials, the newer oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban) have proven to be similarly effective (dabigatran 110 mg, rivaroxaban, or edoxaban) or superior (dabigatran 150 mg or apixaban) to warfarin for prevention of stroke and thromboembolism. [60] However, although anticoagulants reduce 30-day mortality from ischemic stroke, these agents increase intracranial hemorrhage–related mortality. [61] If warfarin is chosen for anticoagulation, a target international normalized ratio (INR) of 2-3 is traditionally used in this cohort, as this limits the risk of hemorrhage while providing protection against thrombus formation. Warfarin is also superior to clopidogrel or a combination of clopidogrel and aspirin in the prevention of embolic events in higher-risk patients.

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