This Appropriate Care Guide (ACG) highlights the importance of appropriate anticoagulation and provides clinicians with recommendations on when to initiate anticoagulation, how to select between warfarin and non-vitamin K antagonists, and appropriate follow-up and monitoring of patients.
A supplementary guide on how to switch between agents has also been provided.
This ACG is currently under review to be updated based on the latest evidence where relevant.
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Registered doctors and pharmacists may claim 1 Continuing Medical Education (CME)/Continuing Professional Education (CPE) point under category 3A for reading each ACG.
| Key Messages |
| 1. |
Offer anticoagulation to patients with atrial fibrillation (AF) and a modified CHA2DS2VASc score of 2 or more. |
| 2. |
Choose warfarin or a non-vitamin K antagonist oral anticoagulant (NOAC), based on patient, drug and disease factors.
- Warfarin and NOACs are comparable in preventing AF-related stroke and systemic embolism. NOACs are also known as direct oral anticoagulants (DOACs).
- Warfarin is the only drug with proven safety and efficacy in patients with AF and mechanical heart valves or moderate to severe mitral stenosis.
- Use NOACs only in patients with creatinine clearance 30 mL/min or more (using Cockcroft-Gault formula).
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| 3. |
Review oral anticoagulation at least annually and when patients' clinical circumstances change. |
| 4. |
Use antiplatelet agents selectively based on risk stratification when anticoagulation is contraindicated. Antiplatelet agents are inferior to anticoagulants for preventing AF-related strokes.
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Oral anticoagulation for atrial fibrillation (Nov 2017)
Supplementary guide - Switching between anticoagulants (May 2018)
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