What are the AAN guidelines on secondary stroke prevention in patients with atrial fibrillation (AF)?

Updated: Jan 10, 2016
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AAN guidelines

The AAN guidelines make the following recommendations for selection of patients for antithrombotic therapy [9] :

Level B

Patients should be counseled that the decision to use antithrombotics must be made only after the potential benefit from the stroke risk reduction has been weighed against the potential harm from the increased risk for major bleeding, and clinicians should emphasize the important role of judgment and preferences in this decision.

Clinicians should routinely offer anticoagulation to the following:

  • Patients with nonvalvular atrial fibrillation (NVAF) and a history of TIA or stroke
  • Elderly patients (>75 years) with NVAF who have no history of recent unprovoked bleeding or intracranial hemorrhage

Clinicians might offer oral anticoagulation to patients with NVAF who have dementia or occasional falls. However, clinicians should counsel patients or their families that the risk–benefit ratio of oral anticoagulants is uncertain in patients with NVAF who have moderate to severe dementia or very frequent falls

Clinicians should use a risk stratification scheme to inform their judgment as to which patients with NVAF might benefit more from anticoagulation. However, anticoagulation thresholds suggested by these tools should not be considered definitive indicators of which patients require anticoagulation.

Level C

Clinicians might not offer anticoagulation to patients with NVAF who lack additional risk factors. These patients might reasonably be offered aspirin or no antithrombotic therapy at all.

Level U

Because the risk–benefit ratio of oral anticoagulants in patients with NVAF and end-stage renal disease is unknown, there is insufficient evidence to make recommendations

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