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

Authors Singla A, Mittal M, Flaker G

Received 24 December 2013

Accepted for publication 10 February 2014

Published 25 April 2014 Volume 2014:5 Pages 83—92

DOI https://doi.org/10.2147/RRCC.S39091

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Atul Singla, Mayank K Mittal, Greg C Flaker

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Missouri, Columbia, MO, USA

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 CHADS2 and CHA2DS2-VASc. Although these models have modest predictive ability in individual patients, current guidelines advocate the use of a CHA2DS2-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.

Keywords: atrial fibrillation, anticoagulant therapy, CHADS2, risk stratification, CHA2DS2-VASc, biomarkers

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