DOI: https://doi.org/10.36347/sasjm.2025.v11i12.001

Pages: 1130-1134

This article investigates stroke prevention strategies in low-risk atrial fibrillation (AF) patients aged 65-74, a demographic with increased AF prevalence and stroke risk. While current guidelines advocate oral anticoagulation (OAC) for CHA2DS2-VA scores ≥2, guidance for those with a score of 1 (or CHA2DS2-VASc 2 with female sex) is less clear. We highlight the continuous rise in risk with advancing age and the influence of co-factors like chronic kidney disease, obesity, and smoking. Furthermore, we explore the benefits of anticoagulation, particularly direct oral anticoagulants (DOACs), which offer a more favourable safety profile compared to Vitamin K Antagonists in this age group. Until comprehensive clinical trial data are available for the CHA2DS2-VA 1 cohort, clinical decision-making must employ dynamic and nuanced risk stratification accounting for additional risk factors, AF burden and biomarker assessment to ensure OAC therapy is administered to achieve net clinical benefit.