What is the role of antithrombotic therapy in the treatment of atrial flutter?

Updated: Nov 09, 2018
  • Author: Jesse Borke, MD, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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The 2014 American College of Cardiology, American Heart Association, and the Heart Rhythm Society (AHA/ACC/HRS) guideline for the management of patients with atrial fibrillation (AF) includes recommendations regarding antithrombotic treatment for patients with atrial flutter. [2]  The recommendations are summarized below.

For patients with atrial flutter, the recommendations for antithrombotic therapy are according to the same risk profile used for those with AF. [2] Selection of antithrombotic therapy should be made on the basis of the risk of thromboembolism, irrespective of whether the dysrhythmia pattern is paroxysmal, persistent, or permanent.

For patients with AF with mechanical heart valves, warfarin is recommended. [2]

For patients with nonvalvular AF and history of a previous stroke/transient ischemic attack (TIA), oral anticoagulants (eg, warfarin, dabigatran, rivaroxaban, apixaban) are recommended. [2]

In all other patients with nonvalvular AF, the CHA2DS2-VASc score is recommended to assess stroke risk. [2] CHA2DS2-VASc = congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, stroke/TIA/thromboembolism (doubled), vascular disease (prior myocardial infarction, peripheral artery disease, or aortic plaque), age 65-75 years, sex category (female).

For patients with nonvalvular AF and the following CHA2DS2-VASc scores [2] :

  • 2 or greater: Oral anticoagulants are recommended. For those with severe or end-stage chronic renal disease, warfarin remains the anticoagulant of choice. (Class IIa recommendation)
  • 0: It is reasonable to omit antithrombotic therapy. (Class IIa recommendation)
  • 1: No antithrombotic therapy, aspirin only, or oral anticoagulant therapy may all be considered. (Class IIb recommendation)

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