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 NICE NG196.

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 NICE NG196.

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 NICE NG196.

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 NICE CKS.