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Appropriate Care Guide

Oral anticoagulation for atrial fibrillation Published on 20 November 2017

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.

Download the PDF below to access the full 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).
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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Related Links

Technology Guidance - Drug   Novel oral anticoagulants (NOACs) for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation (rivaroxaban, dabigatran and apixaban)

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