It is widely recognized that stroke is a major hazard for patients with atrial fibrillation (AF). Antithrombotic therapy is the most important management consideration due to the high risk for stroke and the availability of therapy, proven by clinical trials. Aspirin reduces the risk for stroke by 22% compared to placebo and oral anticoagulation (OAC) reduces this risk a further 30-50% compared to aspirin. However, OAC also increases the risk for bleeding, which partly offsets its beneficial effect. Another drawback of OAC is that it requires regular blood monitoring to maintain the international normalized ratio (INR) within the optimal therapeutic window, which is between 2.0 and 3.0 for AF. Balancing each patient’s risk of stroke and of bleeding should help decide whether therapy with aspirin or OAC is most appropriate.
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