What are the current NICE guidelines for the initiation of anticoagulation therapy in patients with atrial fibrillation?

According to NICE guidelines, anticoagulation should be considered for stroke prevention in patients with atrial fibrillation based on their stroke and bleeding risk profiles, using the CHA2DS2-VASc score for stroke risk assessment and the ORBIT score for bleeding risk assessment ¹.

For most people with a CHA2DS2-VASc score of 2 or above, NICE recommends offering a direct-acting oral anticoagulant (DOAC) as first-line treatment, including options such as apixaban, dabigatran, edoxaban, and rivaroxaban ¹.

If a DOAC is contraindicated, not tolerated, or not suitable, warfarin (a vitamin K antagonist) should be offered, with appropriate referral for initiation and monitoring ¹.

Anticoagulation should not be withheld solely based on age or falls risk, and treatment decisions should involve shared decision-making considering the benefits and risks, personal preferences, and clinical factors ¹.