Oral anticoagulation for atrial fibrillation

Published on 20 Nov 2017
Last Updated on 28 Nov 2023

This ACE Clinical Guidance (ACG) highlights the importance of anticoagulation for preventing stroke among patients with atrial fibrillation (AF). The ACG offers evidence-based recommendations and supporting guidance on initiation of anticoagulation, choice of oral anticoagulant (OAC) for different patient groups, and key monitoring parameters as part of regular follow-up of patients on direct oral anticoagulants (DOACs) or warfarin. A supplementary guide on how to switch between medications is included with the ACG.

Download the ACG

Oral anticoagulation for atrial fibrillation (Nov 2023) [PDF]

ACG recommendations

1. Estimate stroke risk for patients with AF and start OAC therapy for those with a modified CHA₂DS₂VASc score ≥ 2.

2. Choose a DOAC as the preferred OAC therapy for patients with AF, except for patients with mechanical heart valves or moderate-to-severe mitral stenosis for whom warfarin is the treatment of choice.

3. Conduct monitoring tests and relevant assessments to ensure the safe use of OAC therapy and to minimise bleeding risk.

4. Reassess stroke risk and review the need for an OAC in patients who are not on OAC therapy at least annually, and when clinical circumstances change.

ACG references

Oral anticoagulation for atrial fibrillation references (Nov 2023) [PDF]