Should Patients With Atrial Fibrillation and 1 Stroke Risk Factor (CHA2DS2-VASc Score 1 in Men, 2 in Women) Be Anticoagulated? Yes: Even 1 Stroke Risk Factor Confers a Real Risk of Stroke.

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Although all clinical scores have modest predictive value for high-risk patients who sustain events, the CHA2DS2-VASc score is clearly superior in identifying low-risk patients with thromboembolism rates <1%/y who do not need any antithrombotic therapy. Evidence of benefit from oral anticoagulation (OAC) treatment exists for reducing stroke and mortality even in the presence of 1 additional stroke risk factor (ie, CHA2DS2-VASc score 1 in men or 2 in women). After all, OAC significantly reduces strokes, thromboembolism, and death in patients with atrial fibrillation (AF). Response by Savino and Halperin on p 1503 The risk of stroke is substantially increased in patients with AF, and stroke prevention with OAC is a pivotal part of the management of this common arrhythmia. OAC reduces the risk of stroke by 64% and all-cause mortality by 26% compared with control.1 Despite compelling evidence of benefit, OAC treatment in AF patients is still underused across different parts of the world.2 The risk of stroke in AF is not homogeneous and varies with age and concomitant comorbidities. Comorbidities have been identified from non-OAC arms of the historical trial cohorts and large epidemiological cohorts. To aid clinicians in determining the risk of stroke, various stroke (and bleeding) risk stratification schemes have been proposed, essentially with the aim to answer the binary question, “Will my patient benefit from OAC treatment?” However, the drawback of OAC treatment is the potential to cause serious bleeding (particular intracranial hemorrhage); thus, the prescribing physician (and patient) has to carefully weigh the benefit and harm. Some focus has been directed to various stroke risk stratification schemes, and we are often asked which is best. In 2008, the Stroke Risk in Atrial Fibrillation Working Group3 compared 12 risk stratification schemes and noted not only …