How much atrial fibrillation is too much? The net clinical benefit of anticoagulation therapy in atrial fibrillation patients with an intermediate CHA2DS2-VASc Score

Background: Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia seen in medical practice, affecting 33.5 million people worldwide. Arterial thromboembolism, particularly ischemic stroke (IS), is a significant complication of AF. The most widely recommended tool used to evaluate AF patient’s risk of IS is the CHA2DS2-VASc score, which assigns a numerical value to predetermined IS risk factors and allows an overall estimation of the patient’s risk by adding these individual numerical values together. Current guidelines offer varying recommendations regarding oral anticoagulation (OAC) therapy use in patients with varying CHA2DS2-VASc scores, especially in those patients with intermediate scores, and so it is difficult for clinicians to know whether OAC use for these patients is beneficial or incurring unnecessary risk. Objective: The purpose of this review is to evaluate the net clinical benefit (NCB) when comparing IS risk to that of hemorrhagic complications when prescribing OAC therapy to patients who have at least 1 nongender-related (NGR) risk factor for IS or an intermediate CHA2DS2-VASc score. Design: Systematic literature review. Methods: Searches were performed on the PubMed database. The search terms used were “Atrial Fibrillation” and “CHA2DS2-VASc” with filters for full text and English. Results: The PubMed search resulted in finding three articles Chao T-F et al.,1 Faucher L et al.,2 and Joundi RA et al.3 Conclusions: Based on our review of the current literature, we found that the presence of even 1 NGR risk factor significantly increases a patient’s risk of IS. Therefore, we agree with the European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guidelines that support considering OAC therapy in AF patients with 1 NGR risk factor, and we suggest that the American College of Cardiology, American Heart Association, and the Heart Rhythm Society (ACC/AHA/HRS) guidelines follow suit