Table 4.

OAC for AF in Specific Clinical Scenarios43, 44, 45, 46, 47

Category	Recommendations
Stable CAD and PAD	NOAC mostly without use of antiplatelet agents
After coronary stenting	Triple therapy with VKA (target INR 2–2.5) or reduced‐dose NOACa, aspirin 75–100 mg/d, and clopidogrel 75 mg/d
	Consider: BMS, abbreviated 6‐mo DAPT for DES, or omission of aspirin if bleeding propensity is high
Secondary stroke prevention	NOACs preferred over VKAs unless TTR >70
	No addition of antiplatelet agent to OAC is needed
Acute stroke	r‐tPA only if anticoagulation by test or history is minimal
	Mechanical thrombectomy for proximal intracranial occlusion
Acute ischemic stroke after neuroimaging (repeat imaging pre‐OAC for moderate to severe ischemic stroke)	TIA: start OAC immediately
	Mild ischemic stroke: start OAC after 3 days
	Moderate ischemic stroke: start OAC at 5–7 days
	Severe ischemic stroke: start OAC at 12–14 days
History of GI bleed	Preference to apixaban and low‐dose dabigatran
End stage renal disease and dialysis	VKA or Apixaban 5 mg b.i.d or Rivaroxaban 15 mg/d
Cardioversion	VKAs and NOACs appear to be similarly effective
AF ablation	Preferred VKA over NOACs (limited data on edoxaban)
Mechanical valves	VKA target INR based on valve type, site, and associated conditions, along with aspirin 75–100 mg daily
Moderate/severe rheumatic mitral stenosis	VKA target INR 2–3

Abbreviations: AF, atrial fibrillation; b.i.d., twice daily; BMS, bare‐metal stents; CAD, coronary artery disease; CrCl, creatinine clearance; DAPT, dual antiplatelet therapy; DES, drug‐eluting stent; GI, gastrointestinal; INR, international normalized ratio; NOAC, new oral anticoagulant; OAC, oral anticoagulants; PAD, peripheral artery disease; r‐tPA, recombinant tissue plasminogen activator; TIA, transient ischemic attack; TTR, time in therapeutic range; VKA, vitamin K antagonist.

^a Apixaban 2.5 mg b.i.d.; rivaroxaban 15 mg daily with food; dabigatran 110 mg b.i.d.