Why do not all patients with atrial fibrillation at high risk of thromboembolism receive oral anticoagulation

The CHA2DS2-VASc scale is commonly used to assess the risk of thromboembolism in patients with atrial fibrillation (AF). Oral anticoagulants are recommended for the prevention of stroke in patients with AF with a CHA2DS2-VASc score of ≥ 2 for men and ≥ 3 for women. There are known factors that have not been included in this scale, but they significantly increase the risk of thromboembolism. Not all patients with AF who are at high risk of thromboembolism receive anticoagulation therapy. This is mainly due to the contraindications to the use of drugs from this group.