Treatment thresholds for stroke prevention in atrial fibrillation: Observations on the CHA2DS2-VASc score

European Heart Journal - Cardiovascular Pharmacotherapy

Volumn 3, Issue 1, 2017, Pages 37-41

  Overvad, Thure Filskov ^a,b   Nielsen, Peter Brønnum ^a,b   Lip, Gregory Y H ^a,c  

^a AALBORG UNIVERSITY   (Denmark)

^b AALBORG UNIVERSITY HOSPITAL   (Denmark)

^c UNIVERSITY OF BIRMINGHAM   (United Kingdom)

Author keywords

Atrial fibrillation; Ischaemic stroke; Oral anticoagulation; Prevention

Indexed keywords

ATRIAL FIBRILLATION; CEREBROVASCULAR ACCIDENT; CHA2DS2-VASC SCORE; COMPARATIVE EFFECTIVENESS; HUMAN; NOTE; PATIENT RISK; PRACTICE GUIDELINE; PRIORITY JOURNAL; RISK ASSESSMENT; RISK FACTOR; SEX DIFFERENCE; CAUSE OF DEATH; COMPLICATION; GLOBAL HEALTH; INCIDENCE; MORTALITY; SURVIVAL RATE; TRENDS;

ANTICOAGULANT AGENT;

ANTICOAGULANTS; ATRIAL FIBRILLATION; CAUSE OF DEATH; GLOBAL HEALTH; HUMANS; INCIDENCE; STROKE; SURVIVAL RATE;

EID: 85019582118     PISSN: 20556837     EISSN: 20556845     Source Type: Journal    
DOI: 10.1093/ehjcvp/pvw022     Document Type: Note

References (42)

1. Rahman F, Kwan GF, Benjamin EJ. Global epidemiology of atrial fibrillation. Nat Rev Cardiol 2014;11:639-654.
2. Schnabel RB, Yin X, Gona P, Larson MG, Beiser AS, McManus DD, Newton-Cheh C, Lubitz SA, Magnani JW, Ellinor PT, Seshadri S, Wolf PA, Vasan RS, Benjamin EJ, Levy D. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: A cohort study. Lancet 2015;386:154-162.
3. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007;146:857-867.
4. Lip GY. Stroke and bleeding risk assessment in atrial fibrillation: when, how, and why?. Eur Heart J 2013;34:1041-1049.
5. Camm JA, Lip GY, de CR, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Knuuti J, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Vardas P, Al-Attar N. 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. Eur Heart J 2012;33:2719-2747.
6. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW. 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.
7. Verma A, Cairns JA, Mitchell LB, Macle L, Stiell IG, Gladstone D, McMurtry MS, Connolly S, Cox JL, Dorian P, Ivers N, Leblanc K, Nattel S, Healey JS. 2014 focused update of the Canadian Cardiovascular Society Guidelines for the management of atrial fibrillation. Can J Cardiol Canadian Cardiovascular Society 2014;30:1114-1130.
8. Lip GY. The CHA2DS2-VASc score for stroke risk stratification in patients with atrial fibrillation: A brief history. Eur Heart J 2015;36:2880-2885.
9. 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.
10. Proietti M, Lane DA, Lip GY. Relation of the SAMe-TT2R2 score to quality of anticoagulation control and thromboembolic events in atrial fibrillation patients: Observations from the SPORTIF trials. Int J Cardiol 2016;216:168-172.
11. Nielsen PB, Chao TF. The risks of risk scores for stroke risk assessment in atrial fibrillation. Thromb Haemost 2015;113:1170-1173.
12. Joundi RA, Cipriano LE, Sposato LA, Saposnik G. Ischemic stroke risk in patients with atrial fibrillation and CHA2DS2-VASc score of 1. Stroke 2016;47:1364-1367.
13. Argulian E, Conen D, Messerli FH. Misconceptions and facts about atrial fibrillation. Am J Med 2015;128:938-942.
14. Olesen JB, Torp-Pedersen C. Stroke risk in atrial fibrillation: Do we anticoagulate CHADS2 or CHA2DS2-VASc 1, or higher?. Thromb Haemost 2015;113: 1165-1169.
15. Friberg L, Skeppholm M, Terént 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.
16. 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.
17. Lip GY, Nielsen PB. Should patients with atrial fibrillation and 1 stroke risk factor (CHA2DS2-VASc score 1 in men, 2 in women) be anticoagulated? Yes: Even 1 stroke risk factor confers a real risk of stroke. Circulation 2016;133:1498-1503.
18. Savino JA, Halperin JL. Should patients with atrial fibrillation and 1 stroke risk factor (C CHA2DS2-VASc score 1 in men, 2 in women) be anticoagulated? The CHA2DS2-VASc 1 conundrum: Decision making at the lower end of the risk spectrum. Circulation 2016;133:1504-1511.
19. Olesen JB, Lip GY, Hansen ML, Hansen PR, Tolstrup JS, Lindhardsen J, Selmer C, Ahlehoff O, Olsen AMS, 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.
20. Olesen JB, Torp-Pedersen C, Hansen ML, Lip GY. The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0-1: A nationwide cohort study. Thromb Haemost 2012;107:1172-1179.
21. Aspberg S, Chang Y, Atterman A, Bottai M, Go AS, Singer DE. Comparison of the ATRIA, CHADS2, and CHA2DS2-VASc stroke risk scores in predicting ischaemic stroke in a large Swedish cohort of patients with atrial fibrillation. Eur Heart J 2016; doi:10.1093/eurheartj/ehw077.
22. Hernan MA, Hernandez-Diaz S, Robins JM. A structural approach to selection bias. Epidemiology 2004;15:615-625.
23. Andersen PK, Geskus RB, de WT, Putter H. Competing risks in epidemiology: Possibilities and pitfalls. Int J Epidemiol 2012;41:861-870.
24. Nielsen PB, Larsen TB, Skjøth F, Overvad TF, Lip GY. Stroke and thromboembolic event rates in atrial fibrillation according to different guideline treatment thresholds: A nationwide cohort study. Sci Rep 2016;6:27410.
25. Lip GY, Nielsen PB, Skjøth F, Lane DA, Rasmussen LH, Larsen TB. The Value of the European Society of Cardiology guidelines for refining stroke risk stratification in patients with atrial fibrillation categorized as low risk using the Anticoagulation and Risk Factors in Atrial Fibrillation stroke score. Chest 2014;146:1337-1346.
26. Lip GY, Skjøth F, Rasmussen LH, Larsen TB. Oral anticoagulation, aspirin, or no therapy in patients with nonvalvular AF with 0 or 1 stroke risk factor based on the CHA2DS2-VASc score. J Am Coll Cardiol 2015;65:1385-1394.
27. Lip GY, Skjøth F, Rasmussen LH, Nielsen PB, Larsen TB. Net clinical benefit for oral anticoagulation, aspirin, or no therapy in nonvalvular atrial fibrillation patients with 1 additional risk factor of the CHA2DS2-VASc score (beyond sex). J Am Coll Cardiol 2015;66:488-490.
28. Lip GY, Nielsen PB, Larsen TB, Skjøth F. Non-valvular atrial fibrillation patients with none or one additional risk factor of the CHA2DS2-VASc score. A comprehensive net clinical benefit analysis for warfarin, aspirin, or no therapy. Thromb Haemost 2015;114:826-834.
29. Fauchier L, Clementy N, Bisson A, Ivanes F, Angoulvant D, Babuty D, Lip GY. Should atrial fibrillation patients with only 1 nongender-related CHA2DS2-VASc risk factor be anticoagulated?. Stroke 2016;47:1831-1836.
30. Bosco JL, Silliman RA, Thwin SS, Geiger AM, Buist DS, Prout MN, Yood MU, Haque R, Wei F, Lash TL. A most stubborn bias: no adjustment method fully resolves confounding by indication in observational studies. J Clin Epidemiol 2010;63:64-74.
31. Singer DE, Chang Y, Fang MC, Borowsky LH, Pomernacki NK, Udaltsova N, Go AS. The net clinical benefit of warfarin anticoagulation in atrial fibrillation. Ann Intern Med 2009;151:297-305.
32. Connolly SJ, Eikelboom JW, Ng J, Hirsh J, Yusuf S, Pogue J, de CR, Hohnloser S, Hart RG. Net clinical benefit of adding clopidogrel to aspirin therapy in patients with atrial fibrillation for whom vitamin K antagonists are unsuitable. Ann Intern Med 2011;155:579-586.
33. Wagstaff AJ, Overvad TF, Lip GY, Lane DA. Is female sex a risk factor for stroke and thromboembolism in patients with atrial fibrillation?. A systematic review and meta-analysis. Qjm 2014;107:955-967.
34. Olesen JB, Fauchier L, Lane DA, Taillandier S, Lip GY. Risk factors for stroke and thromboembolism in relation to age among patients with atrial fibrillation: The Loire Valley Atrial Fibrillation Project. Chest 2012;141:147-153.
35. Mikkelsen A, Lindhardsen J, Lip GY, Gislason GH, Torp-Pedersen C, Olesen JB. Female sex as a risk factor for stroke in atrial fibrillation: A nationwide cohort study. J Thromb Haemost 2012;10:1745-1751.
36. Overvad TF, Rasmussen LH, Skjøth F, Overvad K, Albertsen IE, Lane DA, Lip GY, Larsen TB. Female sex as a risk factor for thromboembolism and death in patients with incident atrial fibrillation. The prospective Danish Diet, Cancer and Health study. Thromb Haemost 2014;112:789-795.
37. Camm JA, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van GIC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De CR, De SJ, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le HJY, Ponikowski P, Rutten FH. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369-2429.
38. Dreyer NA, Tunis SR, Berger M, Ollendorf D, Mattox P, Gliklich R. Why observational studies should be among the tools used in comparative effectiveness research. Health Aff 2010;29:1818-1825.
39. Albertsen IE, Rasmussen LH, Lane DA, Overvad TF, Skjøth F, Overvad K, Lip GY, Larsen TB. The impact of smoking on thromboembolism and mortality in patients with incident atrial fibrillation: Insights from the Danish Diet, Cancer, and Health study. Chest 2014;145:559-566.
40. Szymanski FM, Lip GY, Filipiak KJ, Platek AE, Hrynkiewicz-Szymanska A, Opolski G. Stroke risk factors beyond the CHA2DS2-VASc score: Can we improve our identification of 'high stroke risk' patients with atrial fibrillation?. Am J Cardiol 2015;116:1781-1788.
41. Lane DA, Lip GY. Patient's values and preferences for stroke prevention in atrial fibrillation: Balancing stroke and bleeding risk with oral anticoagulation. Thromb Haemost 2014;111:381-383.
42. Lahaye S, Regpala S, Lacombe S, Sharma M, Gibbens S, Ball D, Francis K. Evaluation of patients' attitudes towards stroke prevention and bleeding risk in atrial fibrillation. Thromb Haemost 2014;111:465-473.