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Most patients with atrial fibrillation need anticoagulants, NICE says

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g4100 (Published 17 June 2014) Cite this as: BMJ 2014;348:g4100
  1. Ingrid Torjesen
  1. 1London

Almost all patients with atrial fibrillation should be offered anticoagulant therapy to prevent stroke, and a large proportion of these should be offered novel oral anticoagulants, says an updated guideline on atrial fibrillation from the National Institute for Health and Care Excellence (NICE).1

In contrast to NICE’s 2006 recommendations,2 which focused on identifying the 45% patients at the greatest risk of stroke and offering them anticoagulation, doctors should now try to identify the 6-10% of patients at the lowest risk of stroke and offer anticoagulation to the rest, Campbell Cowan, chairman of the guideline development group, told a press conference in London on 17 June.

The new guideline recommended that doctors use a new tool—the CHA2DS2-VASc—to assess the risk of stroke in people with atrial fibrillation to help distinguish between those with a low risk who do not need anticoagulation and those with a higher risk who do. Around 200 000 patients with atrial fibrillation are currently prescribed aspirin for stroke prevention, but Cowan said that …

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