Can Patients With Atrial Fibrillation Be Optimally Risk Stratified for Stroke and Thromboembolism?

To the Editor:Atrial fibrillation (AF) has repeatedly been shown to be associated with a substantial risk of stroke, but this risk is not consistent across all populations. Identifying patients at greatest risk of this (sometimes disastrous) complication is problematic. Therefore, the development of various stroke risk stratification models based on data from large clinical studies has proved useful in targeting anticoagulation to those at moderate-high risk of stroke, whereas those considered at low risk are generally offered aspirin as an alternative, despite the limited evidence for aspirin in this setting.1 These stratification schema have been incorporated into various expert consensus2 and evidence-based3 guidelines on the management of AF. Of note, these available stroke risk stratification schema have been developed—and largely validated—using data from patients not receiving oral anticoagulation (OAC) in clinical trial cohorts.4,5It is therefore with great interest that we …