Anticoagulation for Patients with Atrial Fibrillation

The goal of this website is to improve care for patients with atrial fibrillation. Atrial fibrillation is the most common form or sustained arrhythmia. In 2012, an estimated 2.3 million people in the U.S. were affected with atrial fibrillation. One of the most devastating complications of atrial fibrillation is stroke and in 2007, a meta-analysis of studies found that treatment with adjusted-dose warfarin reduced stroke by 62% and demonstrated low rates of major hemorrhage (1). The newer oral anticoagulants (apixaban, dabigatran and rivaroxaban) are at least as good as warfarin at preventing stroke with half the rate of intracranial hemorrhage.

Despite the effectiveness of anticoagulation, current practice still does not follow published guidelines, resulting in preventable ischemic stroke. Underuse of anticoagulants may be due, in part, to concerns of bleeding especially in the elderly. Since rates of stroke in persons aged 70 years and older are higher than in younger patients, those who would benefit from anticoagulation the most are the least likely to receive it.

Novel Oral Anticoagulants

The newer anticoagulants are safe, effective and require less monitoring than warfarin. This website is designed to be a very practical tool to help guide providers who care for patients with atrial fibrillation. The goals are to review information regarding each drug, help identify patients who would benefit from anticoagulation, help chose the right anticoagulant for each patient and help manage care for patients who are on these medications.

The clinical trials included only patients with non-valvular atrial fibrillation. Valvular atrial fibrillation refers to patients with moderate to severe mitral stenosis. Therefore, non-valvular atrial fibrillation includes all patients except those with moderate to severe mitral stenosis.

Click on each of the drug names above to find drug specific information.

Clinical Tools for Providers

Tools for assessing risk: This will summarize how to determine the risk of stroke and the risk of bleeding for each patient

Algorithm for choosing an anticoagulant: This algorithm will help guide you through the major decision making points to determine if your patient needs an anticoagulant and which one may be a good fit for that patient

Procedure Advisor: Recommendations at Duke for invasive and non-invasive procedures

Bleeding Advisor: How to manage a patient who presents with bleeding while taking one of these medications


Disclaimer: recommendations on this website are made for providers in the Duke Health System and therefore they may not be consistent with guidelines or package inserts.

Clinical Guide for Use of Oral Anticoagulants