Atrial Fibrillation Stroke Prevention in the CHA2DS2-VASc Era
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During the past decade, 2 substantial advancements in atrial fibrillation (AF) management have shifted the clinical paradigm for thromboembolic risk reduction. The introduction and validation of the CHA2DS2-VASc score resulted in a refined clinical understanding of AF stroke risk, particularly among individuals identified as having a low risk of thromboembolism by the previously embraced CHADS2 score.1 The popularity of CHA2DS2-VASc quickly grew, and current AF management guidelines recommend this algorithm for AF stroke risk assessment and decision making.2,3 At the same time, new medications (and devices) became available as alternatives to warfarin for prevention of thromboembolism. Although anticoagulation with warfarin has long stood as the cornerstone of AF-associated stroke prevention, the drawbacks of this treatment have been well recognized. Direct oral anticoagulant (DOAC) therapy has emerged as an efficacious and safe anticoagulation strategy that eliminates many of the inconveniences and some of the risks imposed by vitamin K antagonism.4 The temporal proximity of these advances in anticoagulation and stroke risk stratification was fortuitous; as the CHAD2DS-VASc score identified a new cohort of previously low-risk patients now at sufficient stroke risk to warrant anticoagulation, DOAC therapy overcame many of the perceived barriers to warfarin use.
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