(HealthDay News) — Most people with nonvalvular atrial fibrillation (NVAF) should be taking oral anticoagulants to prevent stroke, according to an American Academy of Neurology (AAN) guideline published in the February 25 issue of Neurology.

Antonio Culebras, MD, and colleagues from the Guideline Development Subcommittee of the AAN conducted a systematic literature search to provide an evidence-based update on the prevention of stroke in NVAF.

The authors found that cardiac rhythm monitoring probably detects occult NVAF in patients with recent cryptogenic stroke. Dabigatran, rivaroxaban, and apixaban are likely at least as effective as warfarin in preventing stroke and have a lower risk of intracranial hemorrhage for patients with NVAF. The guideline also extends the value of these to patients who may be generally undertreated, including the elderly, those with mild dementia, and those at moderate risk of falls. Warfarin is more effective than clopidogrel plus aspirin in preventing stroke, but has a higher risk of intracranial bleeding. Compared to aspirin alone, clopidogrel plus aspirin probably reduces stroke risk but increases the risk of major hemorrhage.

“Clinicians might obtain outpatient cardiac rhythm studies in patients with cryptogenic stroke to identify patients with occult NVAF (Level C) and should routinely offer anticoagulation to patients with NVAF and a history of TIA/stroke (Level B),” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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