Perspectives: Lessons Learned From VKAs

Raffaele De Caterina

Raffaele De Caterina


  • Professor and Director
  • Institute of Cardiology
  • University Chieti, Italy
  • Consultant
  • "G. Monasterio" Foundation for Medical Research
  • Pisa, Italy


The use of stroke risk assessment tools

It would be helpful to consider both stroke and bleeding risk scores in patients that will be treated with anticoagulants. The CHADS2 score is a very simple way of assessing the risk. We know that for the vast majority of patients, the CHADS2 score is a very simple score that can immediately identify patients at higher risk.

Now, we do have some uncertainty for patients that have a CHADS2 score of 1, and sometimes also for patients that have a 0 CHADS2 score, because the former guidelines were somehow ambivalent about the traditional anticoagulants and aspirin. Now, this patient category has been clarified in the new ESC guidelines with the use of the CHA2DS2-VASc score, which eliminates a lot of the grey area, and allocates most of these patients to treatment with anticoagulants.

I think there will be increasingly more patients treated with anticoagulants, for whom there was previously some uncertainty regarding whether or not to put them on this type of therapy. But it will be a very good exercise to try to revalidate the new risk scores with all of the new anticoagulants.

About the Coagulation Center

The Coagulation Center is an educational resource for healthcare professionals. Guided by a global editorial board of experts, the Coagulation Center offers a range of clinical perspectives on balancing the benefit and risk of anticoagulation in a rapidly changing landscape. Within the Coagulation Center you will find roundtable discussions on anticoagulation management, materials for patient management including patient case studies, tools to help evaluate bleeding risk and stroke risk, and downloadable resources for your practice.