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Controlled studies of new oral anticoagulants (NOACs) in patients with atrial fibrillation have included above all patients at high risk of stroke, providing solid evidence on the benefits of anticoagulant therapy with such drugs in male patients with CHA2DS2-VASc score ≥2 and in women with a score of ≥3. Although estimates of stroke risk in patients with lower scores predominantly come from studies in patients not receiving NOAC, in many of these subjects anticoagulant therapy still seems able to provide clinical benefit. The current guidelines therefore recommend oral anticoagulant therapy in patients with CHA2DS2-VASc ≥1 in men and ≥2 in women. However, the use of this therapy must be carefully weighted with the expected reduction in the risk of stroke, the risk of bleeding and the patient's preferences. The paradygmatic case of a patient with CHA2DS2-VASc score 1 is reported in which acetylsalicylic acid therapy is substituted with dabigatran 150 mg / day in order to guarantee the patient maximum protection against the risk of stroke, without exposing him to an excessive risk of bleeding (Cardiology).

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