Prophylactic Therapy to Reduce the Risk of Stroke in Patients with Atrial Fibrillation

The prophylactic therapy to reduce risk of stroke in patients with atrial fibrillation depends on the age of the patient and other risk factors.

Risk factors:

(1) age of the patient

(2) concurrent conditions

(3) past medical history

Risk	General Treatment Guidelines (1996)
low	neither aspirin nor warfarin indicated
medium	either aspirin or warfarin can be used
high	warfarin is the drug of choice; if warfarin cannot be given, aspirin can be used

Risk	General Treatment Guidelines (1999)
under 60 years of age with no risk factors	none, or aspirin
low	aspirin or warfarin (INR 1.6 to 3.0)
medium	aspirin or warfarin
high	warfarin (INR 2.5 to 3.0, consider 1.6 to 2.5 if >= 75 years), or aspirin
previous TIA or CVA	warfarin (INR 2.5 to 4.0), or warfarin (INR 2.5) PLUS aspirin

where:

• If a patient cannot tolerate aspirin, then an alternative antiplatelet agent might be tried, such as clopidogrel or dipyridamole.

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