Treatment

Document Overview

Design and created by Guideline Central in participation with the American Heart Association and American Stroke Association.

Prevention Of Stroke In Nonvalvular Atrial Fibrillation

American Heart Association

American Stroke Association

Publication Date: Feb 23, 2014

Page Last Updated: May 6, 2026

Classification of Management Recommendations

Classification	Definition
Level (A)	Denotes a practice recommendation that must be done. In almost all circumstances, adherence to the recommendation will improve healthrelated outcomes. Almost all patients in this circumstance would desire that the recommendation be followed.
Level (B)	Corresponds to the helping verb should. Should recommendations tend to be more common, as the requirements are less stringent but still based on the evidence and benefit-risk profile.
Level (C)	Corresponds to the helping verb may. May recommendations represent the lowest allowable recommendation level the AAN considers useful within the scope of clinical practice and can accommodate the highest degree of practice variation.
Level (U)	Indicates that the available evidence is insufficient to support or refute the efficacy of an intervention.
Level (R)	Assigned when the balance of benefits and harms is unknown and the intervention is known to be exorbitantly expensive or have important risks. This level designates that the intervention should not be used outside of a research setting.

* In exceptional cases, one convincing Class I study may suffice for an "A" recommendation if 1) all criteria are met, 2) the magnitude of effect is large (relative rate improved outcome > 5 and the lower limit of the confidence interval is > 2).

Document Overview

Document Title: Prevention Of Stroke In Nonvalvular Atrial Fibrillation

Authoring Societies

American Heart Association

American Stroke Association

Endorsing Society: American Academy of Neurology

Document Publication Date: Feb 23, 2014

Page Last Reviewed/Updated: May 6, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.ahajournals.org/doi/10.1161/STR.0b013e318266722a

Source Citation: Furie KL, Goldstein LB, Albers GW, Khatri P, Neyens R, Turakhia MP, Turan TN, Wood KA; on behalf of the American Heart Association Stroke Council, Council on Quality of Care and Outcomes Research, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease. Oral Antithrombotic Agents for the Prevention of Stroke in Nonvalvular Atrial Fibrillation: A Science Advisory for Healthcare Professionals From the American Heart Association/American Stroke Association. PMID: 22858728

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: Revise management recommendations on the safety and efficacy of a thrombin inhibitor (dabigatran) and 2 factor Xa inhibitors (rivaroxaban and apixaban) in preventing stroke in patients with atrial fibrillation (AF).

Scope: Assessment and Screening, Management, Prevention

Diseases/Conditions (MeSH)

D001281 - Atrial Fibrillation

Keywords: atrial fibrillation, chronic kidney disease, echocardiography, gastrointestinal

Target Patient Population: Adults with atrial fibrillation (AF)

Inclusion Criteria: Male, Female, Adult

Health Care Settings: Emergency Care, Hospital, Operating and Recovery Room, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resources: Methodology Supplement Evidence Tables

Number of Source Documents: 40

Literature Search End Date: Thursday, February 28, 2013

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Prevention Of Stroke In Nonvalvular Atrial Fibrillation

Treatment

Aspirin, Clopidogrel & Warfarin

Dabigatran

Apixaban

Rivaroxaban

Classification of Management Recommendations

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology