What is the most effective and safest delivery of thromboprophylaxis in atrial fibrillation?

2012 focused update of the ESC Guidelines for the management of atrial fibrillation

“…warfarin, international normalized ratio (INR) 2.0 -3.0]. 16 Stroke risk is a continuum and the predictive value of artificially categorizing AF patients into low, moderate, and high-risk strata only has modest predictive value for identifying the 'high-risk' category of patients who would subsequently suffer strokes. 17 Until recently, the only oral anticoagulant (OAC) available was the VKA class of drugs (e.g.…”

Why do not all patients with atrial fibrillation at high risk of thromboembolism receive oral anticoagulation?

“…rivaroxaban) -as part of antithrombotic prevention in patients with AF. In 2012, the update of the 2010 guidelines was released; further evidence has emerged in favor of the new OACs [15]. It has been proven that ASA in the prevention of stroke may be harmful and there is no evidence confirming its effectiveness in the prevention of thromboembolic complications in patients with AF [16].…”

Association between Morphodynamic Variables by Transesophageal Echocardiography and CHA2DS2-Vasc Values

“…8 On the other hand, in patients considered to be at high risk, antithrombotic therapy is recommended through oral anticoagulation. 9 The benefits of antithrombotic therapy are not yet evident in patients considered to be at moderate risk. According to the latest European guideline on the management of AF (2016), oral anticoagulation is recommended for patients considered to be at moderate risk, but the risk of bleeding complications and the patients' preference should be assessed first (Class IIa level of evidence A), as also proposed by the latest guidelines of the American Heart Association/ American College of Cardiology Foundation (2011), which recommends considering the use of aspirin or oral anticoagulation (Class IIa).…”