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AHA/ACC/HRS Updates Guideline on Atrial Fibrillation Management

February 7, 2019

The American Heart Association (AHA), the American College of Cardiology (ACC), and the Heart Rhythm Society (HRS) published updated recommendations for atrial fibrillation (AF) management, particularly with regards to anticoagulation therapy.

The AHA/ACC/HRS now recommend non-vitamin K oral anticoagulants (NOACs) (i.e., dabigatran, rivaroxaban, apixaban, and edoxaban) over warfarin to reduce stroke risk in eligible patients with AF. Eligible patients include men with a CHA2DS2-VASc* score of 2 or greater and women with a score of 3 or greater. Patients with moderate-to-severe mitral stenosis or a mechanical heart valve are not eligible for NOACs; warfarin is still the recommended anticoagulant for this patient population.

Oral anticoagulation is now recommended to reduce the risk of stroke in AF men with a CHA2DS2-VASc score of 1 and AF women with a score of 2. The updated guideline emphasized that female sex, in the absence of other AF risk factors, does not increase the risk of stroke.  

*CHA2DS2-VASc: congestive heart failure, hypertension, age > 75 years (doubled), diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism (doubled), vascular disease, age 65 to 74 years, sex category.

 

January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. 2019. [Epub ahead of print]. Full-text article available at: click here. Accessed February 6, 2019.