Patients with atrial fibrillation are divided into 3 risk groups based on their risk factors.4 High-risk factors include: poor left ventricular systolic function, age greater than 75 years, rheumatic mitral valve disease, prosthetic heart valve, prior stroke/TIA or systemic embolism, or hypertension. Patients with high-risk factors require warfarin treatment (if there is a contraindication or refusal to use warfarin, aspirin should be used). Low-risk group characteristics include age less than 65 years and absence of evidence of CAD (clinical or echocardiographic); these patients can be safely treated with aspirin. Moderate-risk factors include diabetes mellitus, CAD with preserved left ventricular systolic function, and age 65 to 75 years. Moderate-risk patients can be treated with warfarin or aspirin if only 1 of the indicated risk factors is present. Patients with more than 1 risk factor should be considered high risk and be treated with warfarin.
- A 63-year-old man with no evidence of CAD.
4. Albers GW, Dalen JE, Laupacis A, et al. Antithrombotic therapy in atrial fibrillation. Chest 2001;199(1 Suppl):194S206S.
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