Adapt From ANTITHROMBOTIC AND THROMBOLYTIC THERAPY, 8TH ED: ACCP GUIDELINES : Executive Summary

Jack Hirsh, Gordon Guyatt, Gregory W. Albers, Robert Harrington and Holger J. Schünemann
Chest June 2008 133 : 71S - 109S ; doi:10.1378/chest.08-0693

Table 2. Target INR for Atrial Fibrillation and Atrial Flutter.

.	INR	DURATION	ALTER NATIVE	ADD
ATRIAL FIBRILLATION	.
A fib, < 75 yr. without RF1 and RF2	.	Long-term	ASA 75-325	.
A fib, with any one of RF2	2.0-3.0	Long-term	ASA 75-325	.
A fib, with two or more of RF2	2.0-3.0	Long-term	.	a
A fib, with RF1	2.0-3.0	Long-term	.	a
A fib, with recurrent emboli.	2.0-3.0	Long-term	.2.5-3.5	Add ASA 75-325
A fib, following cardiac surgery †	2.0-3.0	††	.	.
A fib, <48 hr	Cardiovert w/o anticoag	.	Recommend Heparin during cardioversion	.
A fib. Pre-cardioversion (>48 hr)	2.0-3.0	3 weeks of target INR	TEE pre-cardioversion	.
Post-cardioversion (>48 hr)	2.0-3.0	4 weeks	.I Long-term **	.

ATRIAL FLUTTER.

Same as atrial fibrillation

For Pacific-Asian (exclude caucasian in this region), The INR range of 2.0-3.0 and 2.5-3.5 may be substituted with INR range of 1.6-2.6 and 2.0-3.0 respectively (Requires more validation)

• RF1 = Risk Factors1: History of ischemic stroke or systemic emboli.
• RF2 = Risk Factors2: (1). Age >75 yr, (2). Hypertension. (3). Diabetes Mellitus. (4). CHF/moderate to severe impaired LV systolic function.
• a = add ASA 75-325 mg when there are more risk factors or more emboli.
• † = If >48 hours.
• ††  = The anticoagulation treatment should continue for several weeks following reversion to NSR, particularly if patients have risk factors for thromboembolism. There is no need for long term anticoagulation if atrial fibrillation occurs only post operatively and revert or convert to NSR.
• ** = Base from "Rate vs Rhythm Control" trials, patients should be on long term anticoagulation if they have higher risk factors