Cardiovascular | Atrial Fibrillation: Management - Adult - Inpatient/Ambulatory/Emergency Department
FULL GUIDELINE
Atrial Fibrillation: Management - Adult - Inpatient/Ambulatory/Emergency Department
APPENDICES
Selecting An Oral Anticoagulant for an Atrial Fibrillation Patient
Emergency Department Management of Atrial Fibrillation
Outpatient Management of Atrial Fibrillation
Inpatient Management of Atrial Fibrillation for General Care and IMC Patients (Non-CT Surgery)
Inpatient Management of Atrial Fibrillation For General Care and IMC Patients (CT Surgery)
Digestive Health Center Endoscopy Atrial Fibrillation Algorithm
Atrial Fibrillation (AF): Management - Adult - Inpatient/Ambulatory/Emergency
Department Guideline Summary
Target Population: Patients 18 years or older diagnosed with atrial fibrillation.
Full Guideline: Atrial Fibrillation: Management - Adult - Inpatient/Ambulatory/Emergency Department
KEY POINTS
This clinical practice guideline is based on recommendations in the 2019 Focused Update of the 2014 American Heart
Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) Guideline for the Management of Patients with
Atrial Fibrillation. Key points from this guideline incorporated into the UW Health guideline and related algorithms are listed below.
Anticoagulant-related
points
Anticoagulant use:
• The decision to use an anticoagulant should not be influenced by whether the AF is
paroxysmal or persistent.
• Direct oral anticoagulants (DOACs) are recommended over warfarin except in patients with
moderate to severe mitral stenosis or a prosthetic heart valve.
• Renal and hepatic function should be tested before initiation of a DOAC and at least
annually thereafter.
• In AF patients with a CHA2DS2-VASc score ≥2 in men or ≥3 in women and a creatinine
clearance <15 ml/min or who are on dialysis, it is reasonable to use warfarin or apixaban for
oral anticoagulation.
• Percutaneous left atrial appendage occlusion may be considered for at-risk AF patients with
AF at increased risk of stroke who have contraindications to long-term anticoagulation.
• In at-risk AF patients who have undergone coronary artery stenting, double therapy with
clopidogrel and low-dose rivaroxaban (15 mg daily) or dabigatran (150 twice daily) is
reasonable to reduce the risk of bleeding as compared to triple therapy.
For reversal of certain direct oral anticoagulants:
• Idarucizumab is recommended for the reversal of dabigatran in the event of a life-
threatening bleed or urgent procedure.
• Andexanet alfa (recombinant factor Xa) can be useful for the reversal of rivaroxaban and
apixaban in the event of life-threatening bleeding.
Other notable points:
• Use average of at least 2 blood pressure measurement readings to obtain BP in a patient
with atrial fibrillation.
• AF catheter ablation may be reasonable in symptomatic patients with heart failure and a
reduced ejection fraction to reduce mortality and heart failure hospitalizations.
• Weight loss combined with risk factor modification is recommended for overweight and
obese patients with AF.
• In patients with cryptogenic stroke in whom external ambulatory monitoring is inconclusive,
implantation of a cardiac monitor is reasonable for detection of subclinical AF.
UW Health Atrial Fibrillation Algorithms
• Selecting an Oral Anticoagulant for An Atrial
Fibrillation Patient
• Emergency Department Management of Atrial
Fibrillation
• Outpatient Management of Atrial Fibrillation
• Inpatient Management of Atrial Fibrillation for
General Care and IMC Patients (Non-CT Surgery)
• Inpatient Management of Atrial Fibrillation for General Care
and IMC Patients (CT Surgery)
• Digestive Heart Center Endoscopy Atrial Fibrillation Algorithm
• Atrial Fibrillation – Rate Control Drugs
Effective 04/05/2019. Contact CCKM@uwhealth.org for previous versions.
Copyright © 2019 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission.
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2019CCKM@uwhealth.org