Atrial fibrillation in adults: when should I start anticoagulation and how do I

In adults with atrial fibrillation, anticoagulation therapy should be initiated when the CHA₂DS₂-VASc score is 2 or above, or in some cases with a score of 1 for men, after considering the risk of bleeding ².

Anticoagulation with a direct‑acting oral anticoagulant (DOAC) is recommended as first-line treatment, including options such as apixaban, dabigatran, edoxaban, and rivaroxaban, when used in line with NICE guidance ².

The choice of a specific DOAC should be based on individual patient factors, contraindications, adverse effects, drug interactions, and local prescribing guidelines, following an informed discussion with the patient ².

For dosing, follow the manufacturer's Summaries of Product Characteristics (SPCs) and NICE guidance, which include considerations for renal function, with dose adjustments as necessary, and monitoring renal function during treatment ¹.