Risk Stratification for Stroke in Atrial Fibrillation: A Critique

Ammar M. Killu; Christopher B. Granger; Bernard J. Gersh


Eur Heart J. 2019;40(16):1294-1302. 

In This Article


The decision of whether or not to anticoagulate an individual with AF relies on a balance of numerous factors including the risk-benefit ratio, simplicity and practically of anticoagulation, and incorporation of risk scores with imperfect accuracy. The introduction of NOACs has improved practically; further, they have a lower risk of intracranial bleeding compared with warfarin. Finally, the addition of biomarkers, imaging data and other factors into complex weighted formulas is likely to improve the predictive accuracy, yet may be impractical for everyday use. What is clear is that the CHA2DS2-VASc score can identify patients at low risk who generally do not warrant anticoagulation; for the remainder, consideration for anticoagulation is at least warranted.