April 28, 2003Archives of Internal Medicine
A Clinical Prediction Rule to Identify Patients With Atrial Fibrillation and a Low Risk for Stroke While Taking Aspirin
Key result
A clinical prediction rule identified low-risk AF patients taking aspirin who had a stroke/TIA rate of 1.1 per 100 person-years, comparable to the 1.2 rate in an age-matched community cohort.
Why the study?
Does a clinical prediction rule identify patients with nonvalvular atrial fibrillation taking aspirin who have a low risk of stroke comparable to the general population?
Population
2,501 patients with nonvalvular atrial fibrillation treated with aspirin during participation in 6 clinical…
Comparison
Clinical prediction rule identifying low-risk… vs Age- and sex-matched cohort from the Framingham…
Design
Cohort, Patients were randomly divided into derivation and validation sets
Follow-up
4688.6 person-years of observation (total)
Authors
Discussion
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Member takes
Implication
May support identifying low-risk AF patients on aspirin with population-comparable stroke rates; leaves open whether anticoagulation can be safely omitted pending randomized trials.
Study Design
Type
Cohort (n=2,501)
Multicenter
Yes
Structured PICO
Does a clinical prediction rule identify patients with nonvalvular atrial fibrillation taking aspirin who have a low risk of stroke comparable to the general population?
P
Population
2,501 patients with nonvalvular atrial fibrillation (AF) treated with aspirin during participation in 6 clinical trials
I
Intervention
Clinical prediction rule identifying low-risk patients (defined as no previous stroke or transient ischemic attack, no treated hypertension or systolic blood pressure ≥140 mm Hg, no symptomatic coronary artery disease, and no diabetes)
C
Comparator
Age- and sex-matched cohort from the Framingham Heart Study
O
Outcome
Stroke (ischemic or hemorrhagic) or transient ischemic attackhard clinical
Main Result
Absolute Event Rate: 1.1% vs 1.2%
A simple clinical prediction rule based on the absence of four clinical features identifies patients with atrial fibrillation taking aspirin who have stroke rates comparable to the general population and may not require oral anticoagulation.
Cite This Study
Walraven et al. (2003) conducted a cohort in nonvalvular atrial fibrillation (AF) (n=2,501). Aspirin (in low-risk patients identified by prediction rule) vs. Age- and sex-matched cohort from the Framingham Heart Study was evaluated on stroke (ischemic or hemorrhagic) or transient ischemic attack. A clinical prediction rule identified low-risk AF patients taking aspirin who had a stroke/TIA rate of 1.1 per 100 person-years, comparable to the 1.2 rate in an age-matched community cohort.