| Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | |
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MedLine Citation:
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PMID: 22315271 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The risk of stroke varies considerably across different groups of patients with atrial fibrillation (AF). Antithrombotic prophylaxis for stroke is associated with an increased risk of bleeding. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS: We used the methods described in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines article of this supplement. RESULTS: For patients with nonrheumatic AF, including those with paroxysmal AF, who are (1) at low risk of stroke (eg, CHADS(2) [congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke or transient ischemic attack] score of 0), we suggest no therapy rather than antithrombotic therapy, and for patients choosing antithrombotic therapy, we suggest aspirin rather than oral anticoagulation or combination therapy with aspirin and clopidogrel; (2) at intermediate risk of stroke (eg, CHADS(2) score of 1), we recommend oral anticoagulation rather than no therapy, and we suggest oral anticoagulation rather than aspirin or combination therapy with aspirin and clopidogrel; and (3) at high risk of stroke (eg, CHADS(2) score of ≥ 2), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest dabigatran 150 mg bid rather than adjusted-dose vitamin K antagonist therapy. CONCLUSIONS: Oral anticoagulation is the optimal choice of antithrombotic therapy for patients with AF at high risk of stroke (CHADS(2) score of ≥ 2). At lower levels of stroke risk, antithrombotic treatment decisions will require a more individualized approach. |
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Authors:
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John J You; Daniel E Singer; Patricia A Howard; Deirdre A Lane; Mark H Eckman; Margaret C Fang; Elaine M Hylek; Sam Schulman; Alan S Go; Michael Hughes; Frederick A Spencer; Warren J Manning; Jonathan L Halperin; Gregory Y H Lip; |
Publication Detail:
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Type: Journal Article; Practice Guideline |
Journal Detail:
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Title: Chest Volume: 141 ISSN: 1931-3543 ISO Abbreviation: Chest Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-02-08 Completed Date: 2012-04-13 Revised Date: 2013-05-20 |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: United States |
Other Details:
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Languages: eng Pagination: e531S-75S Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, McMaster University, Hamilton, ON, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Oral Anticoagulants / adverse effects*, therapeutic use* Aspirin / adverse effects, therapeutic use Atrial Fibrillation / blood, complications*, drug therapy* Atrial Flutter / complications, drug therapy Benzimidazoles / adverse effects, therapeutic use Dose-Response Relationship, Drug Drug Therapy, Combination Electric Countershock Evidence-Based Medicine* Fibrinolytic Agents / adverse effects*, therapeutic use* Hemorrhage / blood, chemically induced, prevention & control Humans International Normalized Ratio Risk Factors Societies, Medical* Stroke / blood, prevention & control* Ticlopidine / adverse effects, analogs & derivatives, therapeutic use Vitamin K / antagonists & inhibitors beta-Alanine / adverse effects, analogs & derivatives, therapeutic use |
| Grant Support | |
ID/Acronym/Agency:
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UL1 TR000077/TR/NCATS NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Benzimidazoles; 0/Fibrinolytic Agents; 107-95-9/beta-Alanine; 12001-79-5/Vitamin K; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; A74586SNO7/clopidogrel; I0VM4M70GC/dabigatran |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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