Who will benefit from anticoagulant therapy? Use of the CHADS2 score and its variants

Abstract

Stroke prevention is a crucial step in the management of atrial fibrillation (AF). The assessment of stroke risk associated with AF varies, depending on the presence of various clinical risk factors (older age, congestive heart failure, diabetes mellitus, hypertension, history of stroke or transient ischemic attack, female sex, or peripheral vascular disease) incorporated in risk stratification models such as CHADS 2 and CHA 2 DS 2 -VASc. Although these models have modest predictive ability in individual patients, current guidelines advocate the use of a CHA 2 DS 2 -VASc risk score to identify very low risk patients who can avoid antithrombotic therapy, as well as all others who can benefit from such therapy. More recently biomarkers and imaging has improved our knowledge of pathophysiology of AF and may further improve risk stratification for thromboprophylaxis in AF patients. These new markers combined with clinical risk scores may enable the development of novel tools to improve clinical risk assessment in AF. In this article, we summarize the recent developments in risk stratification for stroke prevention in AF, including the various schemes and new biomarkers that may lead to improved patient outcomes.