Atrial Fibrillation: Thromboembolic Risk Stratification and Selection of Anticoagulant Therapy.
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Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with a significantly increased risk of thromboembolic complications, most commonly ischemic stroke. Appropriate “risk stratification” and selection of anticoagulant therapy is of paramount importance to alleviate morbidity and mortality associated with AF. Aims to review the current evidence pertaining to thromboembolic risk stratification in atrial fibrillation and contemporary approaches to the selection of anticoagulant therapy in routine practice. A systematic review was performed in line with PRISMA guidelines. Searches were performed in PubMed, Scopus, Web of Science and Cochrane Library between 2014 and 2025 for studies related to risk assessment tools and anticoagulant treatment methods in patients with atrial fibrillation. A total of 1,512 records were published. Finally, 46 studies adhered to the inclusion criteria. Risk stratification tools performed well, especially the CHA₂DS₂-VASc score. Direct oral anticoagulants (DOACs) namely, apixaban, rivaroxaban, dabigatran and edoxaban were all relatively more efficacious and safer than vitamin K antagonists.