Note – for valvular a-fib, you have to use warfarin. For non-valvular a-fib, you can use DOACs, the Heparins, and Warfarin. Aspirin may be used for patients with low CHA2DS2-VASc scores.
For pts w/ A-fib w/ RVR (admitted), in anticipation of any procedures that may be done, start patient on Heparin(UFH) continuous infusion. When you are sure that they won’t be any procedures, then switch over to oral anticoagulants. UFH has a half-life of 1.5 hours and pts can usually be cath two hours after stopping the heparin drip.
UFH and LMWH
Heparin IV 70 units/kg bolus, then 15 units/kg/hr infusion; adjust dose based on aPTT and hospital’s nomogram.
Enoxaparin (Lovenox) 1 mg/kg SC twice daily. Use lower doses in renal impairment.
DOACs
Apixaban (Eliquis) 5 mg PO twice daily. Use lower doses with certain patients or medications.
Rivaroxaban 20 mg PO daily with the evening meal. Use a lower dose with renal impairment.
Dabigatran (Pradaxa) 150 mg PO twice daily. Use a lower dose with renal impairment.
Note: When you use DOACs to treat A-fib, you don’t have to load. To treat VTE, you do have to load.
Warfarin
Warfarin individualize the dose to achieve INR 2-3
Aspiring and Clopidogrel
Aspirin 75 to 325 mg PO daily
Clopidogrel 75 mg daily with Aspirin when Warfarin therapy is cannot be done.
Side effects for these medications include
Hemorrhagic events in all of them
HIT in heparin and LMWH
Additional Reading
Recommended Doses of Anticoagulant/Antithrombotic Therapies for Patients with Atrial Fibrillation from the ACC website. Last Accessed May 14, 2019