Table 1.

Anticoagulation for Atrial Fibrillation in Specific Clinical Scenarios14

Stable CAD and PAOD-DOAC mostly without use of antiplatelet agents
After coronary stenting-Triple therapy with VKA (target INR, 2 to 2.5) or reduceddose DOAC*, aspirin 75 to 100 mg/d, and clopidogrel 75 mg /d
-Consider: bare metal stents, abbreviated 6-month dual antiplatelet therapy for drug eluting stent or omission of aspirin if bleeding propensity is high
Secondary stroke prevention-DOACs preferred over VKA unless TTR >70
-No addition of antiplatelet agent to OAC is needed.
Acute stroke-r-tPA only if anticoagulation by test or history is minimal
-Mechanical thrombectomy for proximal intracranial occlusion
Acute ischemic stroke after neuroimaging (repeat imaging pre-OAC for moderate to severe ischemic stroke)- TIA start OAC immediately
- Mild ischemic stroke, start OAC after 3 days
- Moderate ischemic stroke, start OAC at 5 to 7 days
- Severe ischemic stroke, start OAC at 12 to 14 days
History of GI bleed-Preference to apixaban and low dose dabigatran
Hemodialysis- VKA or no OAC (DOACs not approved if CrCl <15 mL/m)
Cardioversion-VKA and DOACS appear to be similarly effective
AF- Ablation-Preferred VKA over DOACS (limited data on edoxaban)
Mechanical valves-VKA target INR based on valve type, site and associated conditions along with aspirin 75 to 100 mg daily
Mod/severe rheumatic mitral stenosisVKA target INR 2 to 3
  • CAD, coronary artery disease; DAOC, direct oral anticoagulants; GI, gastrointestinal; AF, atrial fibrillation; TTR, Time in Therapeutic Range; OAC, oral anticoagulants; TIA; transient ischemic attack; r-tPA, recombinant tissue plasminogen activator; PAOD, peripheral arterial occlusive disease; VKA, vitamin K antagonists.

  • * Apixaban 2.5 mg BID.