According to NICE anticoagulants could help prevent thousands of strokes and premature deaths from atrial fibrillation (AF).
Around 800,000 people in England are known to be at risk of stroke from AF. Of these, half are taking anticoagulants, and one-third are currently taking aspirin.
However, two-thirds of people admitted to a hospital with a stroke caused by AF are not taking recommended anticoagulants. NICE estimates that with effective detection and protection with anticoagulant drugs, 7,000 strokes and 2,000 premature deaths could be avoided each year.
In recognition of this, NICE has updated its guidelines on AF. The guideline recommends that the CHA2DS2-VASc tool should be used to assess stroke risk score in people with symptomatic or asymptomatic paroxysmal, persistent or permanent AF, atrial flutter, or a continuing risk of arrhythmia recurrence after cardioversion back to sinus rhythm.
Patients with a CHA2DS2-VASc score of 2 or above, taking bleeding risk into account, should be offered anticoagulation.
Under updated recommendations, NICE says that novel oral anticoagulants (NOACs), should be offered where appropriate. The NOACs do not require the same regular level of monitoring or dose adjustments as warfarin.
Another new recommendation states that GPs should not offer aspirin monotherapy solely for stroke prevention to people with AF. Evidence shows that aspirin is not as effective as anticoagulants at preventing stroke in people with AF who are at increased risk of stroke, and is also not as safe in terms of causing bleeding. Although the risks of anticoagulation also increase with age, the evidence also shows that its benefits outweigh the risks in the vast majority of people with AF.
Elsewhere, the guidelines say that GPs should provide a personalised package of care to patients with AF to help them understand their condition and make informed choices about their treatment.
This package should be documented and delivered, and should cover factors such as stroke awareness and measures to prevent stoke, rate control, and who to contact if advice is needed. It should also include up-to-date and comprehensive education and information on the cause, effects and possible complications of AF, anticoagulation, and practical advice on anticoagulation.
