Anticoagulation Control and Prediction of Adverse Events in Patients With Atrial Fibrillation

Wan, Yi; Heneghan, Carl; Perera, Rafael; Roberts, Nia; Hollowell, Jennifer; Glasziou, Paul; Bankhead, Clare; Xu, Yiming

doi:10.1161/circoutcomes.108.796185

Cited by 466 publications

(389 citation statements)

References 47 publications

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“…8 The treatment threshold with vitamin K antagonist may even be lower with good quality anticoagulation control, where a high time in therapeutic range (>70%) is achieved, given that a high time in therapeutic range is associated with best efficacy and safety related to vitamin K antagonists. [22][23][24] All clinical risk scoring systems have broadly comparable predictive value for identifying high-risk patients who sustain stroke events. Rather than a categorized approach to stroke risk stratification focusing on high-risk patients, a simple approach to thromboprophylaxis is to initially identify truly low-risk patients in whom OACs could be clearly omitted.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Chao

Lip

Liu

et al. 2016

Stroke

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A trial fibrillation (AF) confers a 5-fold increased risk of stroke compared with patients without AF. 1 The risk of AF-associated stroke is not homogeneous and depends on patients' age and comorbidities, which have resulted in the development of clinical scores to aid stroke risk stratification and guide the use of oral anticoagulation (OAC) for stroke prevention. Currently, the CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female) score is recommended by guidelines for stroke risk stratification in AF 2,3 and has been shown to be better than the older CHADS 2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score for stroke risk stratification among Asian AF patients. 4 Because age is an important driver of ischemic stroke for AF patients, 5 the CHA 2 DS 2 -VASc scheme assigns 1 point forBackground and Purpose-The age threshold for an increased stroke risk for patients with atrial fibrillation may be different for Asians and non-Asians. We hypothesized that a modified CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female) scheme, mCHA 2 DS 2 -VASc, which assigned one point for patients aged 50 to 74 years, may perform better than CHA 2 DS 2 -VASc score for stroke risk stratification in Asians. Methods-This study used the Taiwan National Health Insurance Research Database, which included 224 866 newly diagnosed atrial fibrillation patients. The predictive accuracies of ischemic stroke of CHA 2 DS 2 -VASc and mCHA 2 DS 2 -VASc scores were compared among 124 271 patients without antithrombotic therapies. From the whole cohort, 15 948 patients had a CHA 2 DS 2 -VASc score 0 (males) or 1 (females), and 8654 patients had an mCHA 2 DS 2 -VASc score 1 (males) or 2 (females). The latter were categorized into 3 groups, that is, no treatment, antiplatelet therapy, and warfarin, and the risks of ischemic stroke and intracranial hemorrhage (ICH) were compared. Results-During a follow-up of 538 653 person-years, 21 008 patients experienced ischemic stroke. The mCHA 2 DS 2 -VASc performed better than CHA 2 DS 2 -VASc score in predicting ischemic stroke assessed by C indexes and net reclassification index. For 8654 patients having an mCHA 2 DS 2 -VASc score of 1 (males) or 2 (females) because of the resetting of the age threshold, use of warfarin was associated with a 30% lower risk of ischemic stroke and a similar risk of ICH compared with nontreatment. Net clinical benefit analyses also favored the use of warfarin in different weighted models. patients aged between 65 and 74 years and 2 points for those aged ≥75 years. 6 However, the age threshold for an increased risk of ischemic stroke for Asians may be lower than that of Caucasians. Conclusions-In7 For Asian AF patients with a CHA 2 DS 2 -VASc score of 0 (males)...

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Section: Discussionmentioning

confidence: 99%

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Chao

Lip

Liu

et al. 2016

Stroke

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“…9.5.3. Chwiejne wartości międzynarodowego wskaźnika znormalizowanego oraz odpowiednie dawkowanie doustnych leków przeciwzakrzepowych niebędących antagonistami witaminy K Ważnym wskaźnikiem predykcyjnym poważnych krwawień jest TTR podczas stosowania VKA [432,441,494]. U pacjentów otrzymujących VKA zaleca się więc dążenie do INR w przedziale 2,0-3,0, utrzymywane dużego TTR (np.…”

Section: Uprzednio Przebyte Krwawienieunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,319

4,163

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“…460,484 9.5.3 Labile international normalized ratio and adequate non-vitamin K antagonist oral anticoagulant dosing TTR on VKA therapy is an important predictor of major haemorrhage. 432,441,494 Therefore, we recommend targeting the INR between 2.0 and 3.0 in patients on VKAs, maintaining a high TTR (e.g. ≥70% 494 ), and to consider switching to a NOAC when a high TTR cannot be sustained.…”

Section: Previous Bleeding Eventmentioning

confidence: 99%

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof¹,

Benussi²,

Kotecha³

et al. 2016

Eur J Cardiothorac Surg

893

591

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Anticoagulation Control and Prediction of Adverse Events in Patients With Atrial Fibrillation

Abstract: Background-To date, there has been no systematic examination of the relationship between international normalized ratio (INR) control measurements and the prediction of adverse events in patients with atrial fibrillation on oral anticoagulation.

Cited by 466 publications

References 47 publications

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

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Anticoagulation Control and Prediction of Adverse Events in Patients With Atrial Fibrillation

Abstract: Background-To date, there has been no systematic examination of the relationship between international normalized ratio (INR) control measurements and the prediction of adverse events in patients with atrial fibrillation on oral anticoagulation.

Cited by 466 publications

References 47 publications

Validation of a Modified CHA 2 DS 2 -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Validation of a Modified CHA 2 DS 2 -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

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Product

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Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation