November 15, 2018
Ver artículo completoRisk stratification for stroke in atrial fibrillation: a critique
Resultado clave
Current risk stratification strategies for stroke in atrial fibrillation, such as the CHA2DS2-VASc score, have several limitations that need to be addressed to improve clinical use.
PICO estructurado
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Población
Patients with atrial fibrillation
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Intervención
Risk stratification strategies for stroke (e.g., CHA2DS2-VASc score)
This review highlights the strengths and limitations of current stroke risk stratification strategies, such as the CHA2DS2-VASc score, in patients with atrial fibrillation.
Resumen
Despite the demonstrable success of oral anticoagulants in reducing the rate of stroke in patients with atrial fibrillation, they continue to be seriously underutilized. Indications for their use as stated in the guidelines incorporate a number of risk score algorithms, the most widely used being the CHA2DS2-VASc score. Nonetheless there are several limitations to the various scores currently in clinical use and a critique of these is the focus of this review. In this review we discuss the pathophysiology of atrial fibrillation and its role in thromboembolic stroke risk. We amalgamate this with the basis of major professional society anticoagulation recommendations with regards to the strengths and limitations of current risk stratification strategies and discuss gaps in our current evidence base and next steps to address those gaps.