The assessment of stroke and bleeding risk in atrial fibrillation: where are we now?

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Patients with AF are at increased risk of thromboembolism and ischemic stroke. Many stroke risk factors, including increasing age, diabetes mellitus, hypertension and congestive heart failure, are themselves associated with the development of AF. The risk of stroke in AF is not homogeneous, and many different risk stratification schemas are available for the evaluation of thromboembolic stroke risk in AF patients. In addition, the risk of bleeding associated with anti-thrombotic therapy also needs to be considered during the anti-thrombotic therapy decision-making process. However, there are few published and validated bleeding risk schema available for AF patients. The availability of user-friendly risk stratification schemas could accurately discriminate patients' risk for stroke and anticoagulant therapy-related bleeding, and improve adherence to guidelines for thromboprophylaxis in AF.