Atrial fibrillation and stroke prevention: brief observations on the last decade

Abstract

Atrial fibrillation (AF) results in a substantial risk of mortality and morbidity from stroke and thromboembolism, and thus, a cornerstone of AF management requires appropriate and effective stroke prevention, which is oral anticoagulation. In the last decade, substantial changes in the landscape of stroke prevention in AF are evident. New knowledge has led to improved treatment options and guidelines have evolved. For example, stroke and bleeding risk assessment has now focused on use of the validated CHA₂DS₂-VASc and HAS-BLED scores, respectively to make clinical decisions. An important clinical practice shift is the initial identification of ‘low-risk’ patients, that is, CHA₂DS₂-VASc score = 0 (male) or 1 (females), who do not need any antithrombotic therapy. Subsequent to this step OAC can be offered to patients with ≥1 stroke risk factors. More recently, the SAMe-TT₂R₂ score has been proposed to aid decision-making, by using simple clinical variables by identifying those AF patients likely to do well on warfarin (SAMe-TT₂R₂ score 0-1) or those more likely to have poor anticoagulation control (SAMe-TT₂R₂ score >2), where a non-vitamin K antagonist oral anticoagulant may be a better option.

Keywords::

• atrial fibrillation
• bleeding
• risk assessment
• stroke

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Erratum

Financial & competing interests disclosure

GYH Lip has served as a consultant for Bayer, Astellas, Merck, Sanofi, BMS/Pfizer, Daiichi-Sankyo, Biotronik, Medtronic, Portola and Boehringer Ingelheim and has been on the speakers bureau for Bayer, BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Medtronic and Sanofi Aventis. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.