[Antithrombotic therapy in patients with atrial fibrillation]

Atrial fibrillation is associated with a higher risk of stroke and peripheral embolism. CHA2DS2-VASc clinical stroke risk score allows to identify patients at 'low stroke risk' (CHA2DS2-VASc score = 0 in men, or 1 in women) who should not be offered antithrombotic therapy. Anticoagulation (especially using new oral anticoagulant agents) is recommended in patients with significant risk of ischemic events (CHADSVASC ≥ 2 in men and ≥ 3 in women), and should be initiated in patients with CHADSVASC ≥ 1 in men and ≥ 2 in women, in absence of major risk for severe bleeding. Risk of bleeding must be evaluated at the time of anticoagulation initiation, as well as during follow- up. Presently, the type of atrial fibrillation (paroxysmal or permanent) should not be considered in the thromboembolism risk stratification process. There is no room for antiplatelet therapy in patients with atrial fibrillation.