Perspectives: Lessons Learned From VKAs

Sarah A. Spinler

Sarah A. Spinler


  • Professor of Clinical Pharmacy
  • Department of Pharmacy Practice and Pharmacy Administration
  • Philadelphia College of Pharmacy
  • University of the Sciences in Philadelphia
  • Philadelphia, Pennsylvania

The use of stroke risk assessment tools

I think people are increasingly utilizing a CHADS2 scoring recommendation for the selection of anticoagulant therapy in practice, as is recommended by the European Society of Cardiology guideline, which suggests that warfarin or dabigatran can be used with patients with a CHADS2 score of 1 or more.

Now, some clinical trials for stroke prevention in atrial fibrillation only enrolled patients that were at higher risk, so I think there will be some healthcare professionals that will say "Okay, this agent could be used in high-risk patients, since it was studied in that patient subgroup. But then, does this mean that practitioners will avoid using it in low-risk patients?"

So I think CHADS2 is just going to be used to identify patients who have one or more significant risk factors. I don’t think it’s going to be used to stratify between agents, because there’s been no head-to-head comparative data.

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.