Consider Treatment

There is strong evidence that men with a CHA2DS2-VASc score of >2 and women with a score >3 benefit from anticoagulation. However there is a growing body of evidence to suggest a favourable benefit to anticoagulation when treating men with a score greater than one and women with score greater than 2. 3

NICE recommends treatment must be decided on an individual basis:

  • Consider anticoagulation for men with a CHA2DS2-VASc score of 1
  • Offer anticoagulation to people with a CHA2DS2-VASc score of 2 or above 1

When deciding treatment the expected stroke reduction, bleeding risk and patient preference should be considered.

Anticoagulation may be with apixaban, dabigatran etexilate, rivaroxaban or a vitamin K antagonist (warfarin).

Take bleeding risk into account using a HAS-BLED score of greater than 2 as a relative contraindication to anticoagulation.

The risks of taking aspirin outweigh any benefits of taking it as monotherapy for stroke prevention in adults with atrial fibrillation, it should therefore not be offered.