CHA 2 DS 2 -VASc Scores and Major Bleeding in Patients With Nonvalvular Atrial Fibrillation Who Are Receiving Rivaroxaban

Peacock, W. Frank; Tamayo, Sally; Patel, Manesh R.; Sicignano, Nicholas; Hopf, K; Yuan, Zuyi

doi:10.1016/j.annemergmed.2016.09.032

Cited by 11 publications

(9 citation statements)

References 32 publications

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“…An association between CHA 2 DS 2 -VASc scores and the incidence of major bleeding has been reported in several previous studies [ 19 , 20 ], in which a higher risk of bleeding was noted in patients with higher CHA 2 DS 2 -VASc scores who were also receiving warfarin or rivaroxaban. We also found a similar association in the patients taking dabigatran or apixaban.…”

Section: Discussionsupporting

confidence: 56%

“…Although it has been reported that higher CHA 2 DS 2 -VASc scores are also associated with an increased incidence of major bleeding in patients receiving warfarin or rivaroxaban [ 19 , 20 ], it is not known whether this phenomenon would be observed in patients taking other NOACs such as dabigatran and apixaban. In this study, we investigated this issue using a nationwide medical insurance claiming database in Taiwan.…”

Section: Introductionmentioning

confidence: 99%

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The CHA2DS2-VASc Score Predicts Major Bleeding in Non-Valvular Atrial Fibrillation Patients Who Take Oral Anticoagulants

Lee

Chang

Yeh

et al. 2018

JCM

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Background: Patients with atrial fibrillation (AF) are at a substantial risk of ischemic stroke. The CHA2DS2-VASc score predicts the risk of thromboembolism, but its role in predicting major bleeding in patients taking oral anticoagulants is unclear. Methods: We used the National Health Insurance Research Database (NHIRD) of Taiwan to identify patients with AF from 2010 to 2016. They were divided into four groups according to the oral anticoagulants. The outcomes were ischemic stroke/systemic thromboembolism, and major bleeding. Results: A total of 279,776 patients were identified. Ischemic stroke or systemic embolism events were observed in 1.73%, 3.62%, 4.36%, and 5.02% of the patients in the apixaban, rivaroxaban, dabigatran, and warfarin groups, respectively. Major bleeding was recorded in 1.18%, 2.66%, 3.23%, and 4.70% of the patients in the apixaban, rivaroxaban, dabigatran, and warfarin groups, respectively. The highest rates for both ischemic stroke and bleeding events occurred in the patients with a CHA2DS2-VASc score of five or more. Conclusion: Non-valvular AF patients with high CHA2DS2-VASc scores are susceptible to both systemic thromboembolism and major bleeding. The trend was consistently observed in patients who took non-vitamin K oral anticoagulants (NOACs) or warfarin. NOACs might be potentially more effective in reducing overall events.

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

The CHA2DS2-VASc Score Predicts Major Bleeding in Non-Valvular Atrial Fibrillation Patients Who Take Oral Anticoagulants

Lee

Chang

Yeh

et al. 2018

JCM

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“…However, these risk scores have only moderate predictive accuracy, especially in the elderly 20. Further complicating matters is the fact that an increased bleeding risk is correlated with an increased stroke risk, since strong bleeding risk factors such as increasing age, vascular disease, or prior stroke are the most important risk factors for ischemic stroke 21–23…”

Section: Anticoagulation and High Bleeding Riskmentioning

confidence: 99%

<p>When to withhold oral anticoagulation in atrial fibrillation – an overview of frequent clinical discussion topics</p>

Seelig¹,

Pisters²,

Hemels³

et al. 2019

VHRM

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Stroke prevention with oral anticoagulants in patients with atrial fibrillation predisposes for bleeding. As a result, in select patient groups anticoagulation is withheld because of a perceived unfavorable risk-benefit ratio. Reasons for withholding anticoagulation can vary greatly between clinicians, often leading to discussion in daily clinical practice on the best approach. To guide clinical decision-making, we have reviewed available evidence on the most frequently reported reasons for withholding anticoagulation: previous bleeding, frailty and age, and an overall high bleeding risk.

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“…Overall, there is a consistent, elevated risk of bleeding, particularly GI bleeding, in rivaroxaban patients compared with warfarin, dabigatran and apixaban users. There appears to be an increased risk in the elderly, those with a higher CHA 2 DS 2 -VASc score and those age >75 years [49,50,60,61]. There are currently risk scores for the assessment of bleeding risk, including the often-used HAS-BLED score [62].…”

Section: The Issue Of Gi Bleedingmentioning

confidence: 99%

Comparative effectiveness of rivaroxaban in the treatment of nonvalvular atrial fibrillation

Norby

Alonso

2017

J. Comp. Eff. Res.

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Rivaroxaban is a direct oral anticoagulant (DOAC) approved for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, a common arrhythmia. In this review, we summarize the effectiveness of rivaroxaban versus warfarin and the DOACs dabigatran, apixaban and edoxaban. The primary focus is on primary evidence from clinical trials, indirect comparison studies and real-world studies. While there are gaps in the literature, the evidence thus far indicates that rivaroxaban is superior to warfarin and similar to dabigatran, apixaban and edoxaban for the prevention of stroke or systemic embolism in patients with nonvalvular atrial fibrillation, although rivaroxaban may be associated with an elevated bleeding risk compared with other DOACs.

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CHA 2 DS 2 -VASc Scores and Major Bleeding in Patients With Nonvalvular Atrial Fibrillation Who Are Receiving Rivaroxaban

Abstract: Higher CHADS-VASc scores are associated with increased incidence of major bleeding in nonvalvular atrial fibrillation patients receiving rivaroxaban.

Cited by 11 publications

References 32 publications

The CHA2DS2-VASc Score Predicts Major Bleeding in Non-Valvular Atrial Fibrillation Patients Who Take Oral Anticoagulants

The CHA2DS2-VASc Score Predicts Major Bleeding in Non-Valvular Atrial Fibrillation Patients Who Take Oral Anticoagulants

<p>When to withhold oral anticoagulation in atrial fibrillation – an overview of frequent clinical discussion topics</p>

Comparative effectiveness of rivaroxaban in the treatment of nonvalvular atrial fibrillation

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