Should Atrial Fibrillation Patients With Only 1 Nongender-Related CHA 2 DS 2 -VASc Risk Factor Be Anticoagulated?
Why the study?
Does oral anticoagulation improve net clinical benefit and reduce stroke/systemic embolism in atrial fibrillation patients with 1 non-gender-related stroke risk factor?
Population
8,962 unselected patients with atrial fibrillation, of which 2,208 had 0 or 1 non-gender-related stroke risk…
Comparison
Oral anticoagulation (OAC) vs No antithrombotic therapy or antiplatelet therapy
Design
Cohort
Follow-up
1028±1189 days
Authors
Discussion
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Member takes
Implication
May support OAC in AF with 1 NGR factor; leaves open need for randomized confirmation.
Key Points
- The aim is to evaluate whether patients with atrial fibrillation and only 1 nongender-related stroke risk factor should receive anticoagulation.
- Analyzed a community-based cohort of 8962 patients with atrial fibrillation.
- Compared adverse outcomes between patients with 0 and 1 NGR stroke risk factors.
- Calculated net clinical benefit of oral anticoagulation compared to no therapy and antiplatelet therapy.
- The yearly rate of stroke/systemic embolism in nonanticoagulated patients with 1 NGR risk factor was 2.09% (95% CI, 1.37-3.18).
- Patients with 1 NGR risk factor had an adjusted hazard ratio of 2.82 (95% CI, 1.32-6.04) for stroke compared to those with 0 risk factors.
- Positive net clinical benefit for oral anticoagulation use versus no therapy or antiplatelet therapy, indicating it is more effective.
Structured PICO
Does oral anticoagulation improve net clinical benefit and reduce stroke/systemic embolism in atrial fibrillation patients with 1 non-gender-related stroke risk factor?
P
Population
8,962 unselected patients with atrial fibrillation, of which 2,208 (25%) had 0 or 1 non-gender-related (NGR) stroke risk factors (CHA2DS2-VASc 0 versus 1 in males; and 1 versus 2 in females).
I
Intervention
Oral anticoagulation (OAC)
C
Comparator
No antithrombotic therapy or antiplatelet therapy
O
Outcome
Combined end point of stroke/systemic embolism and net clinical benefit (balancing ischemic stroke reduction against increased risk of intracranial hemorrhage)hard clinical
Oral anticoagulation provides a positive net clinical benefit for the prevention of stroke and thromboembolic events in atrial fibrillation patients with exactly 1 non-gender-related stroke risk factor.
Cite This Study
Fauchier et al. (2016) studied this question.