Is an oral anticoagulant necessary for young atrial fibrillation patients with a CHA2DS2-VASc score of 1 (Men) or 2 (Women)?

Journal of the American Heart Association

Volumn 5, Issue 10, 2016, Pages

  Hung, Yuan ^a   Chao, Tze Fan ^b,c   Liu, Chia Jen ^b,c   Tuan, Ta Chuan ^b,c   Lin, Yenn Jiang ^b,c   Chang, Shih Lin ^b,c   Lo, Li Wei ^b,c   Hu, Yu Feng ^b,c   Liao, Jo Nan ^b,c   Chung, Fa Po ^b,c   Lin, Wen Yu ^a   Lin, Wei Shiang ^a   Cheng, Shu Meng ^a   Chen, Tzeng Ji ^b   Lip, Gregory Y H ^d   Chen, Shih Ann ^b,c  

^a TRI SERVICE GENERAL HOSPITAL   (Taiwan)

^b TAIPEI VETERANS GENERAL HOSPITAL   (Taiwan)

^c NATIONAL YANG MING UNIVERSITY   (Taiwan)

^d UNIVERSITY OF BIRMINGHAM   (United Kingdom)

Author keywords

Age; Atrial fibrillation; CHA2DS2 VASc score; Ischemic stroke; Non vitamin K antagonist oral anticoagulants

Indexed keywords

ANTIVITAMIN K; WARFARIN; ANTICOAGULANT AGENT;

ADULT; AGE DISTRIBUTION; AGED; ANTICOAGULANT THERAPY; ARTICLE; ASIAN; ATRIAL FIBRILLATION; BRAIN ISCHEMIA; CARDIOVASCULAR DISEASE ASSESSMENT; CHA2DS2 VASC SCORE; CONGESTIVE HEART FAILURE; CONTROLLED STUDY; DATA BASE; FATALITY; FEMALE; HAZARD RATIO; HUMAN; HYPERTENSION; MAJOR CLINICAL STUDY; MALE; MIDDLE AGED; PRIORITY JOURNAL; RISK ASSESSMENT; RISK FACTOR; SEX; SHARED DECISION MAKING; AGE; CEREBROVASCULAR ACCIDENT; COMPLICATION; FACTUAL DATABASE; ORAL DRUG ADMINISTRATION; SEX DIFFERENCE; TAIWAN; YOUNG ADULT;

ADMINISTRATION, ORAL; ADULT; AGE FACTORS; AGED; ANTICOAGULANTS; ATRIAL FIBRILLATION; DATABASES, FACTUAL; FEMALE; HUMANS; MALE; MIDDLE AGED; RISK ASSESSMENT; SEX FACTORS; STROKE; TAIWAN; YOUNG ADULT;

EID: 84994399434     PISSN: None     EISSN: 20479980     Source Type: Journal    
DOI: 10.1161/JAHA.116.003839     Document Type: Article

References (23)

1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983-988.
2. Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS, Benjamin EJ, D'Agostino RB. Stroke severity in atrial fibrillation. The Framingham Study. Stroke. 1996;27:1760-1764.
3. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P; Guidelines ESCCfP. 2012 Focused update of the ESC guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33:2719-2747.
4. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW; Members AATF. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130: e199-e267.
5. Chao TF, Liu CJ, Wang KL, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chen TJ, Lip GY, Chen SA. Should atrial fibrillation patients with 1 additional risk factor of the CHA2DS2-VASc score (beyond sex) receive oral anticoagulation? J Am Coll Cardiol. 2015;65:635-642.
6. Eckman MH, Singer DE, Rosand J, Greenberg SM. Moving the tipping point: the decision to anticoagulate patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes. 2011;4:14-21.
7. Chao TF, Liu CJ, Wang KL, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chen TJ, Lip GY, Chen SA. Using the CHA2DS2-VASc score for refining stroke risk stratification in "low-risk" Asian patients with atrial fibrillation. J Am Coll Cardiol. 2014;64:1658-1665.
8. Chao TF, Liu CJ, Tuan TC, Chen SJ, Wang KL, Lin YJ, Chang SL, Lo LW, Hu YF, Chen TJ, Chiang CE, Chen SA. Comparisons of CHADS2 and CHA2DS2-VASc scores for stroke risk stratification in atrial fibrillation: which scoring system should be used for Asians? Heart Rhythm. 2016;13:46-53.
9. Chao TF, Wang KL, Liu CJ, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chung FP, Liao JN, Chen TJ, Chiang CE, Lip GY, Chen SA. Age threshold for increased stroke risk among patients with atrial fibrillation: a nationwide cohort study from Taiwan. J Am Coll Cardiol. 2015;66:1339-1347.
10. Chao TF, Liu CJ, Tuan TC, Chen SJ, Wang KL, Lin YJ, Chang SL, Lo LW, Hu YF, Chen TJ, Chiang CE, Chen SA. Rate-control treatment and mortality in atrial fibrillation. Circulation. 2015;132:1604-1612.
11. Chao TF, Liu CJ, Liao JN, Wang KL, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chung FP, Chen TJ, Lip GY, Chen SA. Use of Oral Anticoagulants for Stroke Prevention in Patients With Atrial Fibrillation Who Have a History of Intracranial Hemorrhage. Circulation. 2016;133:1540-1547.
12. Lin LJ, Cheng MH, Lee CH, Wung DC, Cheng CL, Kao Yang YH. Compliance with antithrombotic prescribing guidelines for patients with atrial fibrillation-a nationwide descriptive study in Taiwan. Clin Ther. 2008;30:1726-1736.
13. Chang CH, Lee YC, Tsai CT, Chang SN, Chung YH, Lin MS, Lin JW, Lai MS. Continuation of statin therapy and a decreased risk of atrial fibrillation/flutter in patients with and without chronic kidney disease. Atherosclerosis. 2014;232:224-230.
14. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation. Chest. 2010;137:263-272.
15. Cheng CL, Kao YH, Lin SJ, Lee CH, Lai ML. Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan. Pharmacoepidemiol Drug Saf. 2011;20:236-242.
16. Hsieh CY, Chen CH, Li CY, Lai ML. Validating the diagnosis of acute ischemic stroke in a National Health Insurance claims database. J Formos Med Assoc. 2015;114:254-259.
17. Siu CW, Lip GY, Lam KF, Tse HF. Risk of stroke and intracranial hemorrhage in 9727 Chinese with atrial fibrillation in Hong Kong. Heart Rhythm. 2014;11:1401-1408.
18. Chiang CE, Wang KL, Lip GY. Stroke prevention in atrial fibrillation: an Asian perspective. Thromb Haemost. 2014;111:789-797.
19. Nielsen PB, Chao TF. The risks of risk scores for stroke risk assessment in atrial fibrillation. Thromb Haemost. 2015;113:1170-1173.
20. Siu CW. One more "C" for CHA2DS2-VASc score? J Am Coll Cardiol. 2015;65:1602-1603.
21. Olesen JB, Lip GY, Hansen ML, Hansen PR, Tolstrup JS, Lindhardsen J, Selmer C, Ahlehoff O, Olsen AM, Gislason GH, Torp-Pedersen C. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ. 2011;342:d124.
22. Friberg L, Skeppholm M, Terent A. Benefit of anticoagulation unlikely in patients with atrial fibrillation and a CHA2DS2-VASc score of 1. J Am Coll Cardiol. 2015;65:225-232.
23. Chan YH, Wu LS, Chang SH, Lee HF, Liu JR, See LC, Yeh YH, Kuo CT. Young male patients with atrial fibrillation and CHA2DS2-VASc score of 1 may not need anticoagulants: a nationwide population based study. PLoS One. 2016;11:e0151485.