The American College of Chest Physicians® announced updates to the evidence-based guidelines on antithrombotic therapy for atrial fibrillation. The guideline panel submitted the manuscript, Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report, for publication in the journal CHEST®.
Key recommendations and shifts from previous guidelines include:
• For patients with atrial fibrillation without valvular heart disease, including those with paroxysmal atrial fibrillation who are at low risk of stroke (eg, CHA2DS2VASc score of 0 in males or 1 in females), we suggest no antithrombotic therapy.
• For patients with a single non-sex CHA2DS2VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin or combination therapy with aspirin and clopidogrel.
• For those at high risk of stroke, 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 using a novel oral anticoagulant (NOAC) rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range (TTR) >70%.
• Attention to modifiable bleeding risk factors should be made at each patient contact, and HAS-BLED score should be used to assess the risk of bleeding where high-risk patients (>=3) can be identified for earlier review and follow-up visits.
The complete guideline article is free to view in the Online First section of the journal CHEST.