title: Stroke Risk Factors Beyond the CHA₂DS₂-VASc Score: Can We Improve Our Identification of "High Stroke Risk" Patients With Atrial Fibrillation?
abstract: The prevention of stroke and other thromboembolic events plays a crucial role in the management of patients with atrial fibrillation. Not all patients with atrial fibrillation are equal in terms of thromboembolic risk; therefore, not all will benefit from oral anticoagulation treatment. The general principle is that the expected benefit of anticoagulation in reduction of thromboembolic risk must exceed the expected harm caused by possible bleeding. Some guidelines have focused on a categorical approach to stroke prevention, with a focus on identifying patients at high risk for oral anticoagulation. Various current guidelines recommend assessment of stroke risk using the CHADS2 or CHA2DS2-VASc scores to initially detect patients at low risk who require no antithrombotic therapy. However, the scores do not incorporate all possible risk factors causing a high thromboembolic risk. Factors such as impaired renal function, obstructive sleep apnea, and echocardiographic and biochemical or coagulation parameters can also predict adverse thromboembolic events. The present review aims to describe biomarkers whether blood, urine, imaging (cardiac or cerebral), or clinical that go beyond the CHA2DS2-VASc score and potentially aid stroke risk assessment. Although useful in some cases, the presented parameters should be perhaps used to further refine initial identification of patients at low risk, after which effective stroke prevention can be offered to those with ≥1 additional stroke risk factors.
authors.affiliation: 1(st) Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. Electronic address: filip.szymanski@wum.edu.pl.
authors.forename: Filip M
authors.initials: FM
authors.lastname: Szymanski
authors.affiliation: City Hospital, University of Birmingham Centre for Cardiovascular Sciences, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: 1(st) Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Krzysztof J
authors.initials: KJ
authors.lastname: Filipiak
authors.affiliation: 1(st) Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Platek
authors.affiliation: Department of Cardiology, Hypertension and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Hrynkiewicz-Szymanska
authors.affiliation: 1(st) Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology*; D015415:Biomarkers; D006801:Humans; D017410:Practice Guidelines as Topic; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D013923:Thromboembolism / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D015415:Biomarkers