Table 146135.

Recommendations for Antithrombotic Therapy in Patients With Atrial Fibrillation Based on Thromboembolic Risk Stratification

Patient FeaturesAntithrombotic TherapyGrade of Recommendation
*Risk factors for thromboembolism include HF, LV ejection fraction less than 0.35, and history of hypertension.
AF indicates atrial fibrillation; CAD, coronary artery disease; HF, heart failure; INR, international normalized ratio; LV, left ventricular; and TEE, transesophageal echo.
Age less than 60 years No heart disease (lone AF)Aspirin (325 mg daily) or no therapyI
Age less than 60 years Heart disease but no risk factors*Aspirin (325 mg daily)I
Age greater than or equal to 60 years No risk factors*Aspirin (325 mg daily)I
Age greater than or equal to 60 years With diabetes mellitus or CADOral anticoagulation (INR 2.0–3.0)I
Addition of aspirin, 81–162 mg daily is optionalIIb
Age greater than or equal to 75 years especially womenOral anticoagulation (INR ≈2.0)I
HF LV ejection fraction less than or equal to 0.35 Thyrotoxicosis HypertensionOral anticoagulation (INR 2.0–3.0)I
Rheumatic heart disease (mitral stenosis) Prosthetic heart valves Prior thromboembolism Persistent atrial thrombus on TEEOral anticoagulation (INR 2.5–3.5 or higher may be appropriate)I