IMR Press / RCM / Volume 22 / Issue 2 / DOI: 10.31083/j.rcm2202042
Open Access Review
Thromboembolic risk stratification in atrial fibrillation—beyond clinical risk scores
Darryl Wan1,†Jason Andrade1,2,3,†Zachary Laksman1,*,†
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1 Department of Medicine, Heart Rhythm Services, University of British Columbia, Vancouver, BC V5Y, Canada
2 Department of Medicine, Montreal Heart Institute, University of Montreal, Montréal, QC H2L, Canada
3 Center for Cardiovascular Innovation, Vancouver, BC V5Y, Canada
*Correspondence: (Zachary Laksman)
These authors contributed equally.
Academic Editor: Peter A. McCullough
Rev. Cardiovasc. Med. 2021, 22(2), 353–363;
Submitted: 16 March 2021 | Revised: 2 April 2021 | Accepted: 19 April 2021 | Published: 30 June 2021
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (

Atrial fibrillation (AF) is the most common arrhythmia in the adult general population. As populations age, the global burden of AF is expected to rise. AF is associated with stroke and thromboembolic complications, which contribute to significant morbidity and mortality. As a result, it remains paramount to identify patients at elevated risk of thromboembolism and to determine who will benefit from thromboembolic prophylaxis. Conventional practice advocates the use of clinical risk scoring criteria to identify patients at risk of thromboembolic complications. These risk scores have modest discriminatory ability in many sub-populations of patients with AF, highlighting the need for improved risk stratification tools. New insights have been gained on the utility of biomarkers and imaging modalities, and there is emerging data on the importance of the identification and treatment of subclinical AF. Finally, the advent of wearable devices to detect cardiac arrhythmias pose a new and evolving challenge in the practice of cardiology. This review aims to address strategies to enhance thromboembolic risk stratification and identify challenges with current and future practice.

Atrial fibrillation
Risk scores
Fig. 1.
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