American College of Cardiology/ American Heart Association: Atrial Fibrillation Guidelines (2019)
- Consider oral anticoagulants in men if their CHADS-VASc score is 2 or greater and in women if their score is 3 or greater
- Non-vitamin K oral anticoagulants (e.g. apixaban, rivaroxaban) are recommended over warfarin except in patients with mechanical heart valves
- Aspirin is no longer recommended in patients with low CHADS-VASc scores (<2 in men and <3 in women)
- In patients with atrial fibrillation and acute
coronary syndrome (ACS) consider the following double therapies:
- P2Y12 inhibitor (e.g. ticagrelor or clopidogrel) and warfarin
- Clopidogrel and rivaroxaban 15 mg by mouth daily
- Clopidogrel and dabigatran 150 mg by mouth twice daily
- Note: if a patient is on triple therapy may transition to double therapy at 4-6 weeks
American College of Cardiology/ American Heart Association: Cardiovascular Disease Primary Prevention Guidelines (2019)
- Low Dose Aspirin Use
- Consider use of aspirin for primary ASCVD prevention only in adults 40-70 years of age who have higher ASCVD risk but not an increased bleeding risk
- DO NOT routinely administer for primary ASCVD prevention in patients >70 years of age
- Statin Use
- For diabetic patients (40-75 years) and LDL-C levels greater than or equal to 70 mg/dL regardless of their ASCVD risk obtain a moderate intensity statin, decision to administer a high intensity statin depends on risk enhancing factors
- If any patient has LDL-C levels greater than or equal to 190 mg/dl, regardless of their ASCVD risk, are candidates for high intensity statins
- For non-diabetic patients (40-75 years) and LDL levels greater than or equal to 70 mg/dL with ASCVD risk of 7.5% or greater may consider a moderate intensity statin, however if their ASCVD risk is >20% consider a high intensity statin