Atrial fibrillation and stroke prevention: brief observations on the last decade.

Atrial fibrillation (AF) results in a substantial risk of mortality and morbidity from stroke and thromboembolism, and thus, a cornerstone of AF management requires appropriate and effective stroke prevention, which is oral anticoagulation. In the last decade, substantial changes in the landscape of stroke prevention in AF are evident. New knowledge has led to improved treatment options and guidelines have evolved. For example, stroke and bleeding risk assessment has now focused on use of the validated CHA2DS2-VASc and HAS-BLED scores, respectively to make clinical decisions. An important clinical practice shift is the initial identification of 'low-risk' patients, that is, CHA2DS2-VASc score = 0 (male) or 1 (females), who do not need any antithrombotic therapy. Subsequent to this step OAC can be offered to patients with ≥1 stroke risk factors. More recently, the SAMe-TT2R2 score has been proposed to aid decision-making, by using simple clinical variables by identifying those AF patients likely to do well on warfarin (SAMe-TT2R2 score 0-1) or those more likely to have poor anticoagulation control (SAMe-TT2R2 score >2), where a non-vitamin K antagonist oral anticoagulant may be a better option.