What are the AAN guidelines for prevention of ischemic stroke in patients with nonvalvular atrial fibrillation (AF)?

Updated: May 27, 2020
  • Author: Edward C Jauch, MD, MS, FAHA, FACEP; Chief Editor: Helmi L Lutsep, MD  more...
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The 2011 ACC Foundation (ACCF)/AHA/Heart Rhythm Society (HRS) AF guideline update states that the new anticoagulant dabigatran is useful as an alternative to warfarin in patients with AF who do not have a prosthetic heart valve or hemodynamically significant valve disease. [138] However, a 2012 meta-analysis found an increased risk for MI or acute coronary syndrome with dabigatran. [139]  With the advent of other novel anticoagulants, the American Academy of Neurology (AAN) produced guidelines for the prevention of stroke in nonvalvuar atrial fibrillation in 2014. [140] The guidelines recommend that clinicians should administer dabigatran, rivaroxaban, or apixaban to patients who have nonvalvular atrial fibrillation requiring anticoagulant medication and are at higher risk of intracranial bleeding; they also suggest that clinicians might offer apixaban to patients with nonvalvular atrial fibrillation and GI bleeding risk who require anticoagulant medication. The AAN guidelines recommend that where oral anticoagulants are unavailable, clinicians might offer a combination of aspirin and clopidogrel. This combination was found to be more effective than aspirin for reducting strokes in atrial fibrillation in the ACTIVE trial although it did increase major hemorrhage risk. [141]

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