What is the preferred anticoagulant for a patient with atrial fibrillation and a history of stroke?

For a patient with atrial fibrillation who has a history of stroke, the preferred anticoagulant is indeed warfarin or a direct oral anticoagulant (DOAC). This preference is founded on the significant risk of stroke associated with atrial fibrillation due to the potential for thrombus formation in the left atrial appendage. Anticoagulants are vital in reducing this risk.

Warfarin has been historically used as the standard treatment for stroke prevention in patients with atrial fibrillation, requiring regular monitoring of INR to ensure therapeutic levels. Direct oral anticoagulants, such as dabigatran, rivaroxaban, apixaban, and edoxaban, have emerged as effective alternatives to warfarin, offering advantages such as fixed dosing and no need for routine monitoring. These DOACs have demonstrated comparable effectiveness in stroke prevention, making them a convenient choice for many patients.

Using antiplatelet agents like aspirin or clopidogrel is generally not recommended for stroke prevention in patients with atrial fibrillation, especially in those with a history of stroke, since they are less effective than anticoagulants in this specific context. Heparin is primarily used for acute situations and does not provide the long-term antico