Stroke Risk Predictor Scoring Systems in Atrial Fibrillation.

An effective risk stratification which could help us identify high-risk patients who should take oral anticoagulants (OACs) is the key step for stroke prevention in atrial fibrillation (SPAF). Several scoring systems were available to estimate the risk of stroke in AF, including CHADS2, CHA2DS2-VASc, R2CHADS2 and ATRIA scores, which were constituted of different clinical risk factors. Recently, several new OACs (NOACs) were demonstrated to be at least as effective as warfarin in stroke prevention and were much safer regarding the risk of intra-cranial hemorrhage. In the era of NOACs, the roles of scoring schemes have shifted to identify patients with a truly low-risk of thromboembolic events, in whom OACs were not recommended. The CHA2DS2-VASc score is powerful in selecting "truly low-risk" patients who do not require anticoagulation. Whether the new-emerging scoring systems, R2CHADS2 and ATRIA scores, could further improve the stroke prediction in AF deserves a further study. ("SPAF", the same as the initials of a series of studies about aspirin, warfarin and stroke prevention in AF, was used as the abbreviation for "stroke prevention in atrial fibrillation" in this review article.).