KKey Points ey Points
ÎOne in four individuals aged ≥ 40 years will develop atrial fibrillation (AF) during his or her lifetime.
ÎNonrheumatic AF is a strong, independent predictor of ischemic stroke associated with a fivefold increase in risk, or ~ 5% per year without thromboprophylaxis, but its risk varies considerably across different groups of patients with AF.
ÎOral anticoagulation is the optimal choice of antithrombotic therapy for patients with AF at high risk of stroke.
ÎAt lower levels of stroke risk, antithrombotic treatment decisions will require a more individualized approach that takes into consideration patient values and preferences, bleeding risk, and the presence of non-CHADS2 disease).
stroke risk factors (eg, age 65-74, female gender, vascular
ÎAntithrombotic prophylaxis for stroke (whether with oral anticoagulation or antiplatelet therapy) is associated with an increased risk of bleeding, but the net clinical benefit is in favour of thromboprophylaxis for most patients.
Table 1. CHADS2
C H A D S
CHADS2 Score for Assessment of Stroke Risk in
Patients With Nonrheumatic AF Risk Factor
Recent Congestive heart failure exacerbation History of Hypertension Age ≥ 75 years
Diabetes mellitus Prior history of Stroke or transient ischemic attack
Points 1 1 1 1 2
= congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior
stroke or transient ischemic attack. Other risk factors for stroke include age 65-74 years and female gender, which have been more consistently validated, and vascular disease, which has been less well validated.
Table 2. CHADS2
CHADS2 0 1 2 3 4 5 6
Score and Stroke Rate
Patients (n=1733) 120 463 523 337 220 65 5
Gage BF, et al. JAMA 2001;285(22)2864-2870.
Adjusted Stroke Rate (%/y) (95% confidence interval)
1.9 (1.2-3.0) 2.8 (2.0-3.8) 4.0 (3.1-5.1) 5.9 (4.6-7.3) 8.5 (6.3-11.1) 12.5 (8.2-17.5) 18.2 (10.5-27.4)
