➤ The benefits and risks of anticoagulant use
➤ The patient’s risk assessment tool scores and what they mean when balancing the risk of stroke from atrial fibrillation with the risk of bleeding associated with anticoagulant use
➤ The fact that anticoagulants do not treat atrial fibrillation so patients should not expect the anticoagulants to improve their atrial fibrillation
➤ The importance of talking to a clinician before patients stop taking the medication
➤ Weighing other factors that may influence a patient’s decision to use a DOAC or warfarin, such as
- Age and other factors that may affect risk of stroke or bleeding related to atrial fibrillation
- The need for regular lab testing while taking warfarin to monitor the blood’s ability to clot
- The lack of widespread availability and guidelines for use of DOAC reversal agents
- Insurance coverage and out-of-pocket costs
- The importance of taking medication at the same time every day and monitoring for food, alcohol, and drug interactions
About the EvidenceThis Evidence Update is based on a recently updated systematic review1 which included 320 articles presenting findings from 185 studies published between January 2000 and February 2018. The report updates an earlier version published in 2013.
View the full systematic review update at www.pcori.org/reviews-Afib
1. © 2011–2020 Patient-Centered Outcomes Research Institute. “Stroke Prevention in Atrial Fibrillation Patients: A Systematic Review Update.” Last updated February 20, 2020. https://www.pcori.com/reviews-afib.
2. Sanders GD, Lowenstern A, Borre E, et al. Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update. This systematic review was supported by PCORI through a research partnership with AHRQ. Rockville, MD: AHRQ Publication No. 18-EHC018-EF; 2018. Washington, DC: PCORI Publication No. 2018-SR-04; 2018. DOI: https://doi.org/10.23970/AHRQEPCCER214.
3. 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: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019. pii: S0735-1097 (19)30209-8. doi: 10.1016/jjacc.2019.01.011.
4. Frost JL, Campos-Outcalt D, Hoelting D, LeFevre M, Lin KW, Vaughan W, Bird MD. Updated Clinical Practice Guideline: Pharmacological Management of Newly Detected Atrial Fibrillation. Published April 2017. Available at the American Academy of Family Physicians website: https://www.aafp.org/patient-care/clinical-recommendations/all/atrial-fibrillation.html. Accessed February 27, 2020.
The information in this publication is not intended to be a substitute for professional medical advice.