When AF is diagnosed we have to decide about:
Alternative to anticoagulation exists, like percutaneous closure of the left atrial appendage (LAA).
Anticoagulation if permanent AF or intermittent with a score CHADs-Vasc ≥ 2
Anticoagulation possible and to be evaluated case by case if CHADs-Vasc = 1
No anticoagulation if CHADs-Vasc = 0, age < 65 years and paroxystic AF.
If anticoagulation impossible or not indicated consider percutaneous closure of the left atrial appendage.
Choose based on compliance.
Pay attention to drugs interaction and renal failure with NOAC.
Adapt dose if needed.
Evaluation of bleeding risk with the HAS-BLED score.
If CrCl< 30 give AVK.
For patients with valvular AF or with prosthetic valves only AVK can be given.
Coumadin (AVK) (Acenocoumarol (Sintrom) or (Phenprocoumone (Marcoumar): Target INR between 2 and 3.
Rivaroxaban (Xarelto): 20 mg/day or 15 mg/day.
Dabigatran (Pradaxa): 2x150 mg/day or 2x110 mg/day.
Apixaban (Eliquis): 2x5 mg/day or 2x2.5 mg/day.
Edoxaban (Lixiana): 30 mg/day or 60 mg/day.