Q&A

Clinical decision rules accurately predict stroke risk in atrial fibrillation

J Fam Pract. 2005 April;54(4):303-309
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  • Clinical Question: Which patients with atrial fibrillation would benefit from anticoagulation?
  • Study Design: Decision rule (validation)
  • Setting: Various (meta-analysis)
  • Synopsis: A knee-jerk response of atrial fibrillation = anticoagulation no longer works. If the risk of stroke is low (<2%), the harms of anticoagulation generally outweigh the benefits. If the risk of stroke is high (>4%), the benefits of anticoagulation outweigh the risks for most patients. If the patient’s stroke risk is in between both extremes, we have to look carefully at his or her risk for hemorrhage.
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Bottom Line

Clinical decision rules, especially the well-validated Stroke Prevention in Atrial Fibrillation (SPAF) score, can help identify which groups of patients with atrial fibrillation are likely and unlikely to benefit from anticoagulation. (LOE=1a)

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