Atrial fibrillation: stroke prevention and anticoagulation
What the major U.S. guidelines recommend, with a link to verify each at the source. A quick-reference summary for clinicians, not medical advice.
Anticoagulate by annual thromboembolic risk, not score alone. Class 1 if risk >=2%/yr (CHA2DS2-VASc >=2 men, >=3 women). Class 2a if 1 to 2%/yr (score 1 men, 2 women). DOACs preferred over warfarin except mechanical valve or moderate to severe mitral stenosis (use warfarin). Aspirin alone or with clopidogrel as an OAC alternative is not recommended (Class 3: Harm).
Verify at ACC/AHA/ACCP/HRS →Percutaneous LAA occlusion (eg, Watchman) is reasonable (Class 2a) when there is a long-term contraindication to OAC, upgraded from 2b in 2019. May be a reasonable alternative (Class 2b) at moderate to high stroke risk plus high bleeding risk. Device-detected AHRE >=24h with CHA2DS2-VASc 2: reasonable to start OAC (Class 2a).
Verify at ACC/AHA/ACCP/HRS →