US Guidelines

American College of Cardiology/American Heart Association (ACC/AHA): Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women: JACC State-of-the-Art Review (Cho et al, J Am Coll Cardiol 2020)

The American College of Cardiology/American Heart Association (ACC/AHA) updated its 2011 guidelines for the prevention of cardiovascular disease in women. The recommendations in this update highlight anticoagulation for atrial fibrillation (AF) in women, as well as other topics, such as sex-specific differences in risk factors and response to treatments for cardiovascular disease. Recommendations for stroke prevention in AF by the ACC/AHA/Heart Rhythm Society, the European Society of Cardiology, and the European Heart Rhythm Society/Heart Rhythm Society/Asia Pacific Heart Rhythm Society are summarized and compared.

American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS): 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (January et al, Circulation 2019)
These updated guidelines for the management of AF, published by the AHA/ACC/HRS in 2019 and developed in collaboration with the Society of Thoracic Surgeons (STS), outline risk-based initiation of anticoagulation therapy using the CHADS₂, CHA₂DS₂-VASc, and HAS-BLED risk assessment tools and describe options for rate and rhythm control, including ablation and cardioversion. Management of anticoagulation in specific patient populations, including those with renal impairment and those undergoing ablation, cardioversion, or other invasive procedures, is also addressed. An overview of the risks and benefits of vitamin K antagonists and direct oral anticoagulants (DOACs) is provided.

American College of Chest Physicians (ACCP): Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report (Lip et al, Chest 2018)

The ACCP guidelines describe risk-based antithrombotic therapy for prevention of thrombosis in patients with AF, using the CHA₂DS₂-VASc score to help guide choice of therapy. Considerations for management of anticoagulation in patients undergoing urgent or elective cardioversion, catheter ablation, or other invasive procedure or in patients with AF and concomitant chronic kidney disease (CKD) are provided. Strategies for bleeding management, including use of reversal agents, are described. Sample pathways for determining eligibility for anticoagulation therapy in various clinical scenarios and links to patient education resources are included.

Society of Thoracic Surgeons (STS): The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation (Badhwar et al, Ann Thorac Surg [ATS] 2017)

STS information and guidelines for the treatment of AF through surgical ablation.

American Academy of Family Physicians (AAFP): Updated Clinical Practice Guideline: Pharmacologic Management of Newly Detected Atrial Fibrillation (Frost et al, 2017)

The AAFP clinical practice guideline for the pharmacologic management of newly detected nonvalvular atrial fibrillation (NVAF) was updated in 2017 and includes considerations for rate and rhythm control and chronic anticoagulation. Dosing, estimated cost, benefits, and risks associated with vitamin K antagonists and direct oral anticoagulants (DOACs) are highlighted.

North American Thrombosis Forum (NATF): North American Thrombosis Forum, AF Action Initiative Consensus Document (Ruff et al, Am J Med [AJM] 2016)

The NATF consensus document describes considerations for stroke and bleeding risk assessment using the CHA₂DS₂-VASc and HAS-BLED, respectively, and gives recommendations for anticoagulation therapy in patients with atrial fibrillation. The risks, benefits, and cost-effectiveness of direct oral anticoagulants (DOACs) are outlined. Strategies for management of anticoagulation-related bleeding and use of reversal agents are described, as are approaches to periprocedural management of DOACs in patients undergoing ablation, cardioversion, or other surgeries. Considerations are also provided for treating AF in elderly patients, patients with impaired renal function, patients with concomitant coronary artery disease (CAD), patients who are naïve to or experienced with vitamin K antagonists (VKAs), and patients with subclinical AF, along with strategies for optimizing patient safety and adherence to therapy.

American Heart Association/American Stroke Association (AHA/ASA): Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (Bushnell et al, Stroke 2014)

These guidelines, issued by the AHA/ASA, affirmed by the American Academy of Neurology (AAN), and endorsed by the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS), offer risk reduction strategies for modifiable stroke risk factors that are unique to or more common among women than men, including atrial fibrillation (AF). Risks and benefits of vitamin K antagonists and the oral anticoagulants (DOACs), stratified by sex, are outlined in these guidelines.

American Academy of Neurology (AAN): Summary of Evidence-Based Guideline Update: Prevention of Stroke in Nonvalvular Atrial Fibrillation. Report of the Guideline Development Subcommittee of the American Academy of Neurology (Culebras et al, Neurology 2014)

Published by the AAN in 2014 and endorsed by the World Stroke Organization (WSO), these guidelines include recommendations for anticoagulation management in patients with nonvalvular atrial fibrillation (NVAF), including dosing considerations in the elderly and in those with renal impairment. Risks and benefits of vitamin K antagonists and direct oral anticoagulants (DOACs) are outlined.

American Heart Association/American Stroke Association (AHA/ASA): Guidelines for the Primary Prevention of Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (Meschia et al, Stroke 2014)

The AHA/ASA guidelines for primary stroke prevention were affirmed by the American Academy of Neurology (AAN) and endorsed by the American Association of Neurological Surgeons (AANS), the Congress of Neurological Surgeons (CNS), and the Preventive Cardiovascular Nurses Association (PCNA). They describe primary prevention strategies for patients at risk for stroke, including those with nonvalvular atrial fibrillation (NVAF). Risk stratification schemes for patients with NVAF include the CHA₂DS₂-VASc for stroke risk and the HAS-BLED for bleeding risk. These guidelines provide an overview of the risks and benefits of vitamin K antagonists and direct oral anticoagulants (DOACs) and supplement the science advisory on oral antithrombotic agents for the prevention of stroke in NVAF published by the AHA/ASA and affirmed by the AAN in 2012.

American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS): 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 Practice Guidelines and the Heart Rhythm Society (January et al, Circulation 2014)

These guidelines for the management of AF, published by the AHA/ACC/HRS in 2014 and developed in collaboration with the Society of Thoracic Surgeons (STS), outline risk-based initiation of anticoagulation therapy using the CHADS2, CHA2DS2-VASc, and HAS-BLED risk assessment tools and describe options for rate and rhythm control, including ablation and cardioversion. Management of anticoagulation in specific patient populations, including those with renal impairment and those undergoing ablation, cardioversion, or other invasive procedures, is also addressed. An overview of the risks and benefits of vitamin K antagonists and direct oral anticoagulants (DOACs) is provided.