Thromboembolic risk assessment and hemorrhagic in fibrillation atrial

Abstract

The value of oral anticoagulation for stroke prevention
in atrial fibrillation (AF) is well established. Stroke risk
assessment using the CHA2DS2-VASc score allows identification of patients who are at truly low risk (score=0)
who should need no antithrombotic therapy, while all others (ie, CHA2DS2-VASc score ≥1 with a risk of thromboembolic event >1% per year) would be considered for
oral anticoagulation. The HAS-BLED score has been
recently proposed to easily assess bleeding risk in AF
patients. A score of ≥3 indicates “high risk” and some caution and regular review of the patient are needed. It also
makes the clinician think of correctable common bleeding
risk factors. The new oral anticoagulants (direct thrombin
inhibitor and factor Xa inhibitors) are at least as efficacious and safe as VKAs in non valvular AF. Their advantages are easier use with no monitoring, lower propensityfor food and drug interactions, and lower rates of
intracranial bleeding than with VKAs. They should not
been used in patients with kidney disease at the present
time. Overall, one may expect that more AF patients will
be appropriately treated with oral anticoagulation in the
next years