Adherence to anticoagulation therapy in patients with atrial fibrillation: is a tailored team-based approach warranted?

Assessment of risk factors for stroke and applying anticoagulation accordingly is one of the crucial fundamentals of comprehensive management of atrial fibrillation (AF). As the most prevalent sustained cardiac arrhythmia, AF is known to confer a fivefold increased risk of thromboembolic complications such as ischaemic stroke or transient ischaemic attack.1 International practice guidelines recommend the use of the CHA2DS2-VASc (C - Congestive heart failure; H - Hypertension, A - Age 75 and above, D - Diabetes Mellitus, S - prior Stroke or Transiant Ischaemic Attack or thromboembolism, V - Vascular disease history, A - Age 65-74, S - Female sex) score to predict the yearly risk of stroke and to determine if treatment with oral anticoagulation is warranted. Vitamin K antagonists as well as non-vitamin K antagonist oral anticoagulants (NOACs) are effective for the prevention of strokes in AF. However, regardless of the choice of anticoagulant, stringent adherence to the treatment regimen is crucial. Patients should play an active role in the decision to commence anticoagulation, and patient preferences should be taken into consideration, aiming to tailor the treatment as much as possible which may consequently improve treatment adherence.