{ "release_id": "f6f6f1b6f50379ed", "id": "cardio:oral-anticoagulation", "owner": "cardio", "kind": "intervention", "slug": "oral-anticoagulation", "name": "Blood thinners (oral anticoagulants) to prevent stroke in AF", "aliases": [], "atlases": [ "cardio" ], "summary_plain": "People with atrial fibrillation may be offered a blood thinner to prevent the clots that can cause a stroke. NHLBI names warfarin and the direct-acting oral anticoagulants apixaban, dabigatran, rivaroxaban and edoxaban. Blood thinners can cause bleeding, and MedlinePlus calls bleeding their most common side effect.", "summary_technical": "Parent page for warfarin and the direct oral anticoagulants (DOACs) used in atrial fibrillation. The three DOAC substances with a page here (apixaban, dabigatran, rivaroxaban) were each compared with warfarin in a large randomized trial. Their results are on the substance pages. Edoxaban is named by NHLBI and has no page. Warfarin has no page. The text rests on NHLBI and MedlinePlus patient pages and gives no event rates.", "editorial_state": "draft", "last_substantive_edit": "2026-10-15", "last_evidence_check": "2026-10-14", "next_review_due": null, "identifiers": [], "navigation": { "cardio": { "system": [ "heart" ], "condition-area": [ "arrhythmias", "stroke" ] } }, "payload": { "subtype": "medicine", "mechanism": "Blood thinners stop clots from forming in the blood. They do not break up clots a person already has (MedlinePlus).", "components": null }, "content_digest": "c2392467abed96eb127b1421849f0b649357ac7d757b6cb3b223387fc6010b36", "review": { "content_digest": "c2392467abed96eb127b1421849f0b649357ac7d757b6cb3b223387fc6010b36", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "f6f6f1b6f50379ed", "id": "cardio:claim-acc-aha-2023-af-doac-preferred", "owner": "cardio", "subject_entity_id": "cardio:oral-anticoagulation", "category": "recommendation", "statement": "An ACC summary of the 2023 ACC/AHA atrial fibrillation guideline says that, apart from patients who have mitral stenosis or a mechanical heart valve, direct oral anticoagulants rather than warfarin are the preferred choice.", "context": { "id": "cardio:ctx-acc-aha-2023-patients-with-af", "label": "Patients with atrial fibrillation (ACC summary of the 2023 guideline)", "recipient": "unknown", "population": "Patients with atrial fibrillation. The ACC summary gives no age limits and, apart from the exceptions each claim names, no exclusions.", "care_setting": "Not stated in the ACC summary.", "geography": "Not stated in the ACC summary (issued by American societies; jurisdiction not verified)", "life_stage_note": "Not stated in the ACC summary", "life_stage_terms": null, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (guideline context)", "eligibility": { "inclusion": [ "Patients diagnosed with atrial fibrillation" ], "exclusion": [] } }, "evidence_stage": "guidance", "certainty": "not_assessed", "certainty_method": null, "limitations": "The source is the ACC key-perspectives summary of the guideline (ACC content, hash only), not the guideline text. The summary prints no class of recommendation for this statement and does not say what is preferred in the two exceptions. PubMed lists three corrections to the guideline (2024-01-02, 2024-02-27 and 2024-06-11); their text was not read, so it is not known whether they change anything stated here.", "editorial_state": "draft", "checked_at": "2026-10-15", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Key perspective 4, sentence 3", "applicability_note": "Direct oral anticoagulants preferred over warfarin, with two exceptions.", "snapshot": { "id": "cardio:acc-af2023-key-perspectives-2026-10-15", "retrieved_at": "2026-10-15T13:52:56Z", "content_hash": "351ef6a153a9922b720e0ea62e3c8ccb64abd9945012b3992bb58528d3446453", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:acc-aha-2023-af", "source_type": "guideline", "title": "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines", "canonical_url": "https://doi.org/10.1161/CIR.0000000000001193", "identifiers": [ { "scheme": "doi", "value": "10.1161/CIR.0000000000001193", "normalized_value": "10.1161/cir.0000000000001193", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "38033089", "normalized_value": "38033089", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmcid", "value": "PMC11095842", "normalized_value": "PMC11095842", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2024-01-02", "publisher": "Circulation", "edition": "Published in Circulation 149(1):e1-e156 (issue date 2024-01-02; electronic publication 2023-11-30). PubMed abstract and bibliographic data only. PMC lists an author manuscript (PMC11095842) that is not in the PMC Open Access subset, so it was not fetched. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page (dated Nov 30, 2023), an ACC summary and not the guideline text. In the page markup some less-than symbols hide the text that follows them, so only passages free of such symbols are quoted. The publisher field is the journal title as PubMed gives it.", "reuse_basis": "PubMed record and ACC page. PubMed record fetched through NCBI E-utilities on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. Bibliographic metadata and short quotations from the PubMed abstract, under 25 words each. The full text was not redistributed and the societies' reuse terms were not reviewed. ACC web page fetched with a plain Mozilla/5.0 user agent on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. The ACC's reuse terms were not read, so public text is cite_only: public pages state the summary in the atlas's own words, with a citation and a link, and use no ACC wording. Quote rows are short evidence fragments for the reviewer.", "public_text": "cite_only" } }, { "evidence_role": "context", "locator": "CommentsCorrectionsList, three ErratumIn entries", "applicability_note": "Shows that corrections exist. What they change is unknown.", "snapshot": { "id": "cardio:pubmed-38033089-2026-10-15", "retrieved_at": "2026-10-15T13:48:58Z", "content_hash": "3ee3998a9178e8f21223e2388261924207d5e1f8fb19bf34e8355e11eb2c07a9", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:acc-aha-2023-af", "source_type": "guideline", "title": "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines", "canonical_url": "https://doi.org/10.1161/CIR.0000000000001193", "identifiers": [ { "scheme": "doi", "value": "10.1161/CIR.0000000000001193", "normalized_value": "10.1161/cir.0000000000001193", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "38033089", "normalized_value": "38033089", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmcid", "value": "PMC11095842", "normalized_value": "PMC11095842", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2024-01-02", "publisher": "Circulation", "edition": "Published in Circulation 149(1):e1-e156 (issue date 2024-01-02; electronic publication 2023-11-30). PubMed abstract and bibliographic data only. PMC lists an author manuscript (PMC11095842) that is not in the PMC Open Access subset, so it was not fetched. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page (dated Nov 30, 2023), an ACC summary and not the guideline text. In the page markup some less-than symbols hide the text that follows them, so only passages free of such symbols are quoted. The publisher field is the journal title as PubMed gives it.", "reuse_basis": "PubMed record and ACC page. PubMed record fetched through NCBI E-utilities on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. Bibliographic metadata and short quotations from the PubMed abstract, under 25 words each. The full text was not redistributed and the societies' reuse terms were not reviewed. ACC web page fetched with a plain Mozilla/5.0 user agent on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. The ACC's reuse terms were not read, so public text is cite_only: public pages state the summary in the atlas's own words, with a citation and a link, and use no ACC wording. Quote rows are short evidence fragments for the reviewer.", "public_text": "cite_only" } } ], "review": { "content_digest": "1b3acb141f4dcb194016f0be4d8d82480a2f4c92ed39b024d44de266c18952a2", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/cardio--claim-acc-aha-2023-af-doac-preferred.json" }, { "release_id": "f6f6f1b6f50379ed", "id": "cardio:claim-oral-anticoagulation-prevents-stroke-in-af", "owner": "cardio", "subject_entity_id": "cardio:oral-anticoagulation", "category": "descriptive", "statement": "NHLBI names warfarin and the direct oral anticoagulants (apixaban, dabigatran, rivaroxaban and edoxaban) as medicines that stop clots from forming and so reduce the chance of stroke. It says a person at risk of stroke may need one, and that all of them carry a bleeding risk. MedlinePlus lists atrial fibrillation among the conditions in which a person may need a blood thinner and calls bleeding the most common side effect of blood thinners. Neither page gives a number.", "context": { "id": "cardio:ctx-nhlbi-adults-with-atrial-fibrillation", "label": "Adults with atrial fibrillation, in general terms (NHLBI and MedlinePlus patient pages)", "recipient": "adult", "population": "People with atrial fibrillation, described in general terms. NHLBI puts the number of US adults with atrial fibrillation above 2 million and says the chance of developing it grows with age. The pages do not describe a study population.", "care_setting": "Not applicable (patient information pages, not a study)", "geography": "Not stated in the pages for most statements; the prevalence sentence refers to the United States", "life_stage_note": "Adults in general. NHLBI describes atrial fibrillation as uncommon in children.", "life_stage_terms": null, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (patient information pages)", "eligibility": { "inclusion": [], "exclusion": [] } }, "evidence_stage": "synthesis", "certainty": "not_assessed", "certainty_method": null, "limitations": "Patient information pages. They name edoxaban, which has no page in this atlas. The trial results behind apixaban, dabigatran and rivaroxaban are recorded on their own claims, and the pages give no event rates.", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Page body, Medicines, Blood thinners (fragment 1)", "applicability_note": "NHLBI: blood thinners and DOACs, first part of the sentence.", "snapshot": { "id": "cardio:nhlbi-af-treatment-2026-10-14", "retrieved_at": "2026-10-14T18:19:49Z", "content_hash": "4717eb3d282d9c95f17fc4755692af9a8db61d4e8e2283bbb993b25abde06989", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:nhlbi-af-treatment", "source_type": "webpage", "title": "Atrial Fibrillation Treatment (NHLBI)", "canonical_url": "https://www.nhlbi.nih.gov/health/atrial-fibrillation/treatment", "identifiers": [], "publication_date": null, "publisher": "National Heart, Lung, and Blood Institute (NIH)", "edition": "Page as fetched on 2026-10-14, with the line Last updated on November 30, 2022.", "reuse_basis": "Page of the NHLBI website, fetched as cf-nhlbi-atrial-fibrillation-treatment.html. Only the hash is kept. The NHLBI terms pages tried returned HTTP 404 (cf-nhlbi-website-policies.html, cf-nhlbi-copyright.html), the NIH web-policies pages returned HTTP 403 (cf-nih-web-policies-notices.html, cf-nih-copyright.html), and the NHLBI privacy and accessibility page (cf-nhlbi-website-privacy-accessibility.html) states no copyright terms. The arrhythmia page also credits a copyrighted animation. The reuse terms are therefore unverified, so public text is cite_only: facts are stated in this atlas's own words.", "public_text": "cite_only" } }, { "evidence_role": "supports", "locator": "Page body, Medicines, Blood thinners (fragment 2)", "applicability_note": "NHLBI: these medicines stop clots forming and reduce stroke risk.", "snapshot": { "id": "cardio:nhlbi-af-treatment-2026-10-14", "retrieved_at": "2026-10-14T18:19:49Z", "content_hash": "4717eb3d282d9c95f17fc4755692af9a8db61d4e8e2283bbb993b25abde06989", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:nhlbi-af-treatment", "source_type": "webpage", "title": "Atrial Fibrillation Treatment (NHLBI)", "canonical_url": "https://www.nhlbi.nih.gov/health/atrial-fibrillation/treatment", "identifiers": [], "publication_date": null, "publisher": "National Heart, Lung, and Blood Institute (NIH)", "edition": "Page as fetched on 2026-10-14, with the line Last updated on November 30, 2022.", "reuse_basis": "Page of the NHLBI website, fetched as cf-nhlbi-atrial-fibrillation-treatment.html. Only the hash is kept. The NHLBI terms pages tried returned HTTP 404 (cf-nhlbi-website-policies.html, cf-nhlbi-copyright.html), the NIH web-policies pages returned HTTP 403 (cf-nih-web-policies-notices.html, cf-nih-copyright.html), and the NHLBI privacy and accessibility page (cf-nhlbi-website-privacy-accessibility.html) states no copyright terms. The arrhythmia page also credits a copyrighted animation. The reuse terms are therefore unverified, so public text is cite_only: facts are stated in this atlas's own words.", "public_text": "cite_only" } }, { "evidence_role": "supports", "locator": "Page body, Medicines, Blood thinners", "applicability_note": "NHLBI: who may need them.", "snapshot": { "id": "cardio:nhlbi-af-treatment-2026-10-14", "retrieved_at": "2026-10-14T18:19:49Z", "content_hash": "4717eb3d282d9c95f17fc4755692af9a8db61d4e8e2283bbb993b25abde06989", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:nhlbi-af-treatment", "source_type": "webpage", "title": "Atrial Fibrillation Treatment (NHLBI)", "canonical_url": "https://www.nhlbi.nih.gov/health/atrial-fibrillation/treatment", "identifiers": [], "publication_date": null, "publisher": "National Heart, Lung, and Blood Institute (NIH)", "edition": "Page as fetched on 2026-10-14, with the line Last updated on November 30, 2022.", "reuse_basis": "Page of the NHLBI website, fetched as cf-nhlbi-atrial-fibrillation-treatment.html. Only the hash is kept. The NHLBI terms pages tried returned HTTP 404 (cf-nhlbi-website-policies.html, cf-nhlbi-copyright.html), the NIH web-policies pages returned HTTP 403 (cf-nih-web-policies-notices.html, cf-nih-copyright.html), and the NHLBI privacy and accessibility page (cf-nhlbi-website-privacy-accessibility.html) states no copyright terms. The arrhythmia page also credits a copyrighted animation. The reuse terms are therefore unverified, so public text is cite_only: facts are stated in this atlas's own words.", "public_text": "cite_only" } }, { "evidence_role": "supports", "locator": "Page body, Medicines, Blood thinners (passage 2)", "applicability_note": "NHLBI: bleeding risk.", "snapshot": { "id": "cardio:nhlbi-af-treatment-2026-10-14", "retrieved_at": "2026-10-14T18:19:49Z", "content_hash": "4717eb3d282d9c95f17fc4755692af9a8db61d4e8e2283bbb993b25abde06989", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:nhlbi-af-treatment", "source_type": "webpage", "title": "Atrial Fibrillation Treatment (NHLBI)", "canonical_url": "https://www.nhlbi.nih.gov/health/atrial-fibrillation/treatment", "identifiers": [], "publication_date": null, "publisher": "National Heart, Lung, and Blood Institute (NIH)", "edition": "Page as fetched on 2026-10-14, with the line Last updated on November 30, 2022.", "reuse_basis": "Page of the NHLBI website, fetched as cf-nhlbi-atrial-fibrillation-treatment.html. 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The reuse terms are therefore unverified, so public text is cite_only: facts are stated in this atlas's own words.", "public_text": "cite_only" } }, { "evidence_role": "supports", "locator": "Summary, Who needs blood thinners?", "applicability_note": "MedlinePlus lists atrial fibrillation among conditions that may need a blood thinner.", "snapshot": { "id": "cardio:medlineplus-blood-thinners-2026-10-14", "retrieved_at": "2026-10-14T18:19:51Z", "content_hash": "2b4141ab8f60f42c97c4cc1dc5da568cf7c4073464f1e0fdfe75043f57d8e4c7", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:medlineplus-blood-thinners", "source_type": "webpage", "title": "Blood Thinners | Anticoagulants (MedlinePlus)", "canonical_url": "https://medlineplus.gov/bloodthinners.html", "identifiers": [], "publication_date": null, "publisher": "MedlinePlus, National Library of Medicine", "edition": "Page as fetched on 2026-10-14.", "reuse_basis": "MedlinePlus health-topic page, fetched as cf-medlineplus-bloodthinners.html. 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The raw page is committed at research/snapshots/cf-medlineplus-bloodthinners.html; it also carries licensed images, and only the public-domain summary text is quoted. MedlinePlus says summaries on health topic pages are in the public domain and asks users to acknowledge MedlinePlus as the source (the page titled Linking to and Using Content from MedlinePlus, fetched as cf-medlineplus-usingcontent.html, sha256 31267ce9db016893b80c5665312d92ffc8c34ec86916f84708c353936ba52228). Source: MedlinePlus, National Library of Medicine. 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