Should We Anticoagulate Patients with CHA₂DS₂-VASc Scores of 1?

The CHA₂DS₂-VASc score is used to stratify stroke risk in patients with atrial fibrillation (AF) based on seven features (Congestive heart failure, Hypertension, Age ≥75, Diabetes, prior Stroke or transient ischemic attack, Vascular disease, Age 65–74, and Sex). For patients with nonvalvular AF and scores of ≥2, U.S. guidelines recommend lowering stroke risk with anticoagulation (warfarin or novel anticoagulants; NEJM JW Cardiol Jun 2014 and Circulation 2014 Mar 28; [e-pub]), whereas patients with scores of 1 can be treated with aspirin, anticoagulants, or no agent at all. But are patients with scores of 1 likely to benefit from full anticoagulation? Several recent studies address aspects of this question.

In an analysis of >140,000 Swedish …