Racial ethnic differences should also be considered for the

Racial/ethnic differences should also be considered for the effects of ASA. In the JAST (Japan Atrial Fibrillation Stroke Trial) in 896 Japanese patients with nonvalvular AF [22], the incidence of the primary composite endpoint (i.e., cerebral infarction, TIA, or cardiovascular death) was higher in patients receiving 150−200mg/day ASA (3.1%/year) than in patients not receiving ASA (2.8%/year), and the incidence of serious bleeding in patients receiving ASA was 0.8%/year, which was 4-fold the incidence in patients not receiving ASA (0.2%/year). The JAST was discontinued when these differences were observed in an interim analysis. The JCS 2008 guidelines thus prohibit anticoagulation with ASA in patients with AF.
Anticoagulation for patients receiving warfarin in whom INR is maintained at an optimal level In patient groups in “good control” and “excellent control” with warfarin, who purchase Epothilone B are defined as those with a TTR of 65.5−72.6% and ≥72.6%, respectively, the effects of warfarin therapy in preventing stoke was similar to 150mg bid dabigatran [41]. The risk of major gastrointestinal bleeding was twice higher in patients receiving dabigatran than those receiving warfarin, and the incidence of ICH was lower in those receiving dabigatran. According to these findings, the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Task Force on practice guidelines [42] published a supplementary report on the use of dabigatran and recommended dabigatran for the prevention of stroke in patients with AF (Class I, Level of Evidence: B), although “patients already taking warfarin with excellent INR control may have little to gain by switching to dabigatran.”
Anticoagulation therapy for patients with paroxysmal AF and persistent AF
OAC in patients receiving elective defibrillation In a subanalysis of patients with nonvalvular AF who underwent defibrillation during the RE-LY trial [43], the incidence of stroke or systemic embolism during the first 30 days after defibrillation was low both in the warfarin and dabigatran groups. However, there are no alternatives that may replace the international recommendation stating that “warfarin therapy should be continued for 3 weeks prior to and 4 weeks following elective defibrillation.” In the APHRS survey, patients with paroxysmal and persistent AF were treated similarly. In fact, 72−100% of the physicians used warfarin/dabigatran as monotherapy or combination with antiplatelet agents for patients with persistent AF, and there were scarce differences among the countries. However, kilocalorie may be a problem that as many as 28% of the physicians prescribe monotherapy with antiplatelet agents for patients undergoing cardioversion in India.
Recommendations from APHRS on antithrombotic treatment for nonvalvular AF On the basis of the latest trends in antithrombotic therapy worldwide and the current practices of antithrombotic therapy observed in the APHRS survey, we propose the following recommendations (Table 3).
Conflict of interest