A tailored treatment strategy: a modern approach for stroke prevention in patients with atrial fibrillation

The objective of this review is to provide an overview of modern AF stroke prevention with a focus on tailored treatment strategies. Biomarkers and genetic factors have been proposed to help identify ‘high‐risk’ patients to be targeted for oral anticoagulation, but ultimately their use must be balanced against that of more simple and practical considerations for everyday use. Current guidelines have directed focus on initial identification of ‘truly low‐risk’ patients with AF, that is those patients with a CHA2DS2‐VASc [congestive heart failure, hypertension, age ≥75 years (two points), diabetes mellitus, stroke (two points), vascular disease, age 65–74 years, sex category] score of 0 (male) or 1 (female), who do not need any antithrombotic therapy. Subsequently, patients with ≥1 stroke risk factors can be offered effective stroke prevention, that is oral anticoagulation. The SAMe‐TT2R2 [sex female, age <60 years, medical history (>2 comorbidities), treatment (interacting drugs), tobacco use (two points), race non‐Caucasian (two points)] score can help physicians make informed decisions on those patients likely to do well on warfarin (SAMe‐TT2R2 score 0–2) or those who are likely to have a poor time in therapeutic range (SAMe‐TT2R2 score >2). A clinically focused tailored approach to assessment and stroke prevention in AF with the use of the CHA2DS2VASc, HAS‐BLED [hypertension, abnormal renal/liver function (one or two points), stro...
Source: Journal of Internal Medicine - Category: Internal Medicine Authors: Tags: Review Source Type: research