Management of anticoagulation in rate controlled atrial fibrillation: A three-step approach

Atrial Fibrillation is the most common type of cardiac arrhythmia managed in clinical practice. This condition predisposes patients to a multitude of potential complications that can be managed or prevented by medical or surgical means. Such complications include stroke, hemorrhage, or heart failure, among others. Although surgical intervention may be a viable option in some cases, pharmacological rate-control is a less invasive and more robust method in preventing the genesis of these sequelae. However, current guidelines regarding pharmacologic control of atrial fibrillation sequelae may be difficult to interpret. Based upon clinical prediction rules derived from large-scale clinical trials, we provide a simple three-step sequential algorithm that clinicians may use as guidelines when managing patients with rate controlled atrial fibrillation. These protocols can help clinicians decide if anticoagulation medication is indicated (CHA2DS2-VASc score), select the appropriate agent for anticoagulation (SAMe-TT2R2 score), and anticipate a high risk of hemorrhage (HAS-BLED score).