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Atrial fibrillation - Management
Which antithrombotic treatment should I offer?
- Treatment decisions should be made on an individual basis; the person's bleeding risk, likelihood of compliance with treatment, and preferred options should always be fully assessed before starting treatment.
- Offer people with atrial fibrillation (AF):
- At low risk of stroke — aspirin.
- At high risk of stroke — warfarin.
- At moderate risk of stroke — either aspirin or warfarin.
- If uncertain about stroke risk, start aspirin whilst awaiting specialist assessment.
- CKS does not recommend the use of clopidogrel or a combination of aspirin and clopidogrel for AF in primary care.
- Risk factors have a cumulative effect on stroke risk; this should be considered when discussing treatment options. For example, if the person is in the moderate stroke risk category but has more than one risk factor for stroke (that is, more than one of hypertension, diabetes, coronary artery disease, or peripheral artery disease), there may be a stronger case for choosing warfarin over aspirin.
- For detailed information on the use of aspirin and warfarin in AF, including contraindications, starting doses and titration, monitoring, and adverse effects, see the CKS topics on Antiplatelet treatment and Anticoagulation - oral.
In depth
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