An Updated Review of Target‐Specific Oral Anticoagulants Used in Stroke Prevention in Atrial Fibrillation, Venous Thromboembolic Disease, and Acute Coronary Syndromes

A trial fibrillation (AF) is a common arrhythmia in the adult population. It is associated with up to a 5-fold increased risk of stroke and contributes to a higher morbidity and mortality compared with non-AF-related strokes. Various stroke risk stratification schemes have been developed to quantify stroke risk in patients with AF and guide preventive treatment decisions for the clinician. The most widely used has been the CHADS 2 score, which estimates risk based on the presence of congestive heart failure, hypertension, age 75 years or greater, diabetes mellitus, and prior stroke or transient ischemic attack (TIA). revision of the CHADS 2 scheme has been developed for use in stroke risk assessment in AF. It dichotomizes age and incorporates vascular disease and female sex, to create the CHA 2 DS 2 -VASc (VA, vascular disease; Sc, sex category) score 5 (Table Compared with CHADS 2 , this stroke risk stratification scheme is better able to discriminate among individuals at lowest risk. 8 By both risk stratification schemes, those patients who score 1 are recommended to receive oral anticoagulant therapy unless major contraindications are present. Only those who are <65 years of age and CHADS 2 Adjusted stroke rate 4 (%/year) 1 point Congestive heart failure Hypertension Age 75 Diabetes mellitus Total Points 0: 1.9% 1: 2.8% 2: 4.0% 3: 5.9% 4: 8.5% 5: 12.5% 6: 18.2% 2 points Stroke, TIA, or systemic embolism CHA 2 DS 2 -VASc Annual stroke rate 6 (%/year) 1 point Congestive heart failure Hypertension Age 65 to 74 years Diabetes mellitus Vascular disease (MI, PAD, aortic atheroma) Sex category (female) Total Points 0