FOR APPs & PRIMARY CARE CLINICIANS
Anticoagulation & LAA closure — Quick reference
First steps, urgent findings, referral guidance, and handoff essentials.
First steps
Assess stroke risk, dosing, kidney/liver function, interactions, adherence, bleeding history, and other anticoagulation indications. Calculate CHA2DS2-VASc: OAC is recommended at ≥2 in men or ≥3 in women, unless contraindicated. At 1 in men or 2 in women, consider OAC after individualized discussion.
Recognize the urgent patient
Major active bleeding, instability, suspected intracranial hemorrhage, or acute stroke symptoms requires emergency care.
When to refer
Refer substantial long-term anticoagulation concerns or LAA closure consideration to EP/structural heart for individualized selection.
What to send with the referral
Stroke-risk factors; bleeding records; current drugs/doses; relevant labs; DVT/PE/mechanical-valve history; procedural concerns.
Avoid this pitfall
LAA closure does not treat AF or remove other anticoagulation indications. Postimplant therapy and imaging remain essential.
Reviewed October 11, 2026. This quick reference summarizes the linked guide; use the full guide for context and clinical references.