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Is an Oral Anticoagulant Necessary for Young Atrial Fibrillation Patients With a CHA 2 DS 2 ‐ VASc Score of 1 (Men) or 2 (Women)?

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ABSTRACT

Background: Recent studies demonstrated that oral anticoagulants (OACs) should be considered for patients with atrial fibrillation and 1 risk factor in addition to sex. Because age is an important determinant of ischemic stroke, the strategy for stroke prevention may be different for these patients in different age strata. The aim of this study was to investigate whether OACs should be considered for patients aged 20 to 49 years with atrial fibrillation and a CHA2DS2‐VASc score of 1 (men) or 2 (women).

Methods and results: Using the Taiwan National Health Insurance Research Database, 7374 male patients with atrial fibrillation and a CHA2DS2‐VASc score of 1 and 4461 female patients with atrial fibrillation and a CHA2DS2‐VASc score of 2 and all without antithrombotic therapies were identified and stratified into 3 groups by age. The threshold for the initiation of OACs for stroke prevention was set at a stroke rate of 1.7% per year for warfarin and 0.9% per year for non–vitamin K antagonist OACs. Among male patients aged 20 to 49 years with a CHA2DS2‐VASc score of 1, the risk of ischemic stroke was 1.30% per year and ranged from 0.94% per year for those with hypertension to 1.71% for those with congestive heart failure. Among female patients aged 20 to 49 years with a CHA2DS2‐VASc score of 2, the risk of ischemic stroke was 1.40% per year and ranged from 1.11% per year for those with hypertension to 1.67% for those with congestive heart failure.

Conclusions: For atrial fibrillation patients aged 20 to 49 years with 1 risk factor in addition to sex, non–vitamin K antagonist OACs should be considered for stroke prevention to minimize the risk of a potentially fatal or disabling event.

No MeSH data available.


Related in: MedlinePlus

A flowchart of the enrollment of the study cohort. Among 89 455 AF patients who did not receive oral anticoagulants or antiplatelet agents, there were 12 115 male AF patients with a CHA2DS2‐VASc score of 0 to 1 and 7695 female AF patients with a CHA2DS2‐VASc score of 1 to 2. The risk of ischemic stroke was analyzed for these patients and further stratified on the basis of age. AF indicates atrial fibrillation; NHIRD, National Health Insurance Research Database.
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jah31796-fig-0001: A flowchart of the enrollment of the study cohort. Among 89 455 AF patients who did not receive oral anticoagulants or antiplatelet agents, there were 12 115 male AF patients with a CHA2DS2‐VASc score of 0 to 1 and 7695 female AF patients with a CHA2DS2‐VASc score of 1 to 2. The risk of ischemic stroke was analyzed for these patients and further stratified on the basis of age. AF indicates atrial fibrillation; NHIRD, National Health Insurance Research Database.

Mentions: From January 1, 1996, to December 31, 2003, a total of 153 036 AF patients aged ≥20 years were identified from the NHIRD as the study population. AF was diagnosed using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) code 427.31. To ensure the accuracy of diagnosis, we defined patients with AF only when it was a discharge diagnosis or was confirmed on at least 2 occasions in the outpatient department. The diagnostic accuracy of AF using this definition in NHIRD has been validated previously.12, 13 The CHA2DS2‐VASc score was calculated for each patient by assigning 1 point each for age between 65 and 74 years, history of hypertension, diabetes mellitus, heart failure, vascular disease (myocardial infarction or peripheral artery disease), and female sex and 2 points each for history of stroke, transient ischemic attack, or age ≥75 years.14 Among the study population, we excluded patients at baseline who received treatment with warfarin or any antiplatelet agent, including aspirin, clopidogrel, dipyridamole, and ticlopidine. Finally, a total of 89 455 patients were enrolled into the study cohort; 12 115 men had a CHA2DS2‐VASc score of 0 to 1, and 7695 women had a CHA2DS2‐VASc score of 1 to 2. A flowchart of the enrollment of the study cohort is shown in Figure 1.


Is an Oral Anticoagulant Necessary for Young Atrial Fibrillation Patients With a CHA 2 DS 2 ‐ VASc Score of 1 (Men) or 2 (Women)?
A flowchart of the enrollment of the study cohort. Among 89 455 AF patients who did not receive oral anticoagulants or antiplatelet agents, there were 12 115 male AF patients with a CHA2DS2‐VASc score of 0 to 1 and 7695 female AF patients with a CHA2DS2‐VASc score of 1 to 2. The risk of ischemic stroke was analyzed for these patients and further stratified on the basis of age. AF indicates atrial fibrillation; NHIRD, National Health Insurance Research Database.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121486&req=5

jah31796-fig-0001: A flowchart of the enrollment of the study cohort. Among 89 455 AF patients who did not receive oral anticoagulants or antiplatelet agents, there were 12 115 male AF patients with a CHA2DS2‐VASc score of 0 to 1 and 7695 female AF patients with a CHA2DS2‐VASc score of 1 to 2. The risk of ischemic stroke was analyzed for these patients and further stratified on the basis of age. AF indicates atrial fibrillation; NHIRD, National Health Insurance Research Database.
Mentions: From January 1, 1996, to December 31, 2003, a total of 153 036 AF patients aged ≥20 years were identified from the NHIRD as the study population. AF was diagnosed using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) code 427.31. To ensure the accuracy of diagnosis, we defined patients with AF only when it was a discharge diagnosis or was confirmed on at least 2 occasions in the outpatient department. The diagnostic accuracy of AF using this definition in NHIRD has been validated previously.12, 13 The CHA2DS2‐VASc score was calculated for each patient by assigning 1 point each for age between 65 and 74 years, history of hypertension, diabetes mellitus, heart failure, vascular disease (myocardial infarction or peripheral artery disease), and female sex and 2 points each for history of stroke, transient ischemic attack, or age ≥75 years.14 Among the study population, we excluded patients at baseline who received treatment with warfarin or any antiplatelet agent, including aspirin, clopidogrel, dipyridamole, and ticlopidine. Finally, a total of 89 455 patients were enrolled into the study cohort; 12 115 men had a CHA2DS2‐VASc score of 0 to 1, and 7695 women had a CHA2DS2‐VASc score of 1 to 2. A flowchart of the enrollment of the study cohort is shown in Figure 1.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Recent studies demonstrated that oral anticoagulants (OACs) should be considered for patients with atrial fibrillation and 1 risk factor in addition to sex. Because age is an important determinant of ischemic stroke, the strategy for stroke prevention may be different for these patients in different age strata. The aim of this study was to investigate whether OACs should be considered for patients aged 20 to 49 years with atrial fibrillation and a CHA2DS2‐VASc score of 1 (men) or 2 (women).

Methods and results: Using the Taiwan National Health Insurance Research Database, 7374 male patients with atrial fibrillation and a CHA2DS2‐VASc score of 1 and 4461 female patients with atrial fibrillation and a CHA2DS2‐VASc score of 2 and all without antithrombotic therapies were identified and stratified into 3 groups by age. The threshold for the initiation of OACs for stroke prevention was set at a stroke rate of 1.7% per year for warfarin and 0.9% per year for non–vitamin K antagonist OACs. Among male patients aged 20 to 49 years with a CHA2DS2‐VASc score of 1, the risk of ischemic stroke was 1.30% per year and ranged from 0.94% per year for those with hypertension to 1.71% for those with congestive heart failure. Among female patients aged 20 to 49 years with a CHA2DS2‐VASc score of 2, the risk of ischemic stroke was 1.40% per year and ranged from 1.11% per year for those with hypertension to 1.67% for those with congestive heart failure.

Conclusions: For atrial fibrillation patients aged 20 to 49 years with 1 risk factor in addition to sex, non–vitamin K antagonist OACs should be considered for stroke prevention to minimize the risk of a potentially fatal or disabling event.

No MeSH data available.


Related in: MedlinePlus