What factors should be considered when determining if biomarkers are beneficial to stroke prevention?
When determining if biomarkers are beneficial to stroke prevention, it is important to consider the assay availability, laboratory variability, costs, and added complexity and lower practicality for everyday use. Additionally, many biomarker studies are often based on anticoagulated highly selected clinical trial cohorts, with all included subjects already in the high risk group (CHA2DS2-VASc or CHADS2 [congestive heart failure, hypertension, age, diabetes, stroke (doubled)] score of 2 or greater). Therefore, it is important to consider whether the biomarkers will discriminate/ identify low risk in lower/intermediate risk patients who are not anticoagulated, rather than focus on identifying high risk. Additionally, there should be studies to ascertain the true impact of biomarkers on (non-anticoagulation treated) stroke rates. 