AHA/ASA publish advisory on oral antithrombotics for stroke prevention in nonvalvular artial fibrillation.

www.aafp.org/afp Volume 87, Number 10 ◆ May 15, 2013 Among adults with atrial fibrillation, the annual rate of stroke ranges from 1 to 20 percent, depending on comorbidities and the patient’s history of cerebrovascular events. Because of the risk of bleeding associated with antithrombotics such as warfarin (Coumadin) that are used to reduce the incidence of atrial fibrillation–related stroke, it is important to stratify and identify patients at increased risk of stroke. The CHADS2 (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, or previous stroke or transient ischemic event) scheme can help identify those patients. New antithrombotics provide alternatives to warfarin, and may lower the threshold for thromboembolic risk for initiating therapy in patients with atrial fibrillation. This advisory summarizes existing American Heart Association/American Stroke Association (AHA/ASA) recommendations on antithrombotics for the prevention of first and additional strokes in patients with a history of stroke or transient ischemic attack (TIA). The report also reviews trials assessing the safety and effectiveness of dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis) in preventing stroke in patients with atrial fibrillation, and presents revised management recommendations. Existing Recommendations PREVENTION OF FIRST STROKE