Refinement of Ischemic Stroke Risk in Patients with Atrial Fibrillation and CHA₂DS₂‐VASc Score of 1

Abstract

In AF patients with CHA2 DS2 -VASc score of 1, hypertension confers the highest risk for stroke among other risk factors comprising the score. A more aggressive thromboprophylaxis strategy may be justified among AF patients with CHA2 DS2 -VASc score of 1 due to hypertension.

Patients with atrial fibrillation and CHA2DS2-VASc score 1: “To anticoagulate or not to anticoagulate? That is the question!”

“…Conversely, large studies on Asian populations showed that the incidence of this complication may be significantly higher (2%/year). 19,20,23,24 Similar racial differences were also noted in the recent randomized phase III trials on non-vitamin K antagonists oral anticoagulants. To date, the reasons explaining such racial discrepancies are unclear.…”

Ischemic Stroke and Intracranial Hemorrhage With Aspirin, Dabigatran, and Warfarin

“…Thereby, the use of long-term anticoagulation for stroke prevention in Chinese has been low. 8,10 Recent registry data of Chinese populations from Hong Kong 8 and Beijing, 24 as well as subanalyses of data from the different NOAC trials focusing on Asian populations, [25][26][27] have demonstrated consistently that the risk of ischemic stroke in Chinese patients with AF was comparable with or even higher than that of whites. These findings are in accordance with the fact that globally, China is among the countries with the highest stroke rates.…”

“…Patients diagnosed to have AF in Queen Mary Hospital, Hong Kong, from July 1997 to December 2011, were identified via the computerized database of clinical management system. 8,9,16 Patients were excluded if they had significant valvular heart disease and previous valvular replacement or had incomplete clinical and follow-up data. In addition, patients with AF diagnosed after the commercial availability of dabigatran were also identified ( Figure I in the online-only Data Supplement).…”

“…This fear may be reflected in the gross underutilization of warfarin therapy (15%-20%) and the high prevalence of aspirin therapy (as a perceived alternative to warfarin) in these populations. [8][9][10] Even among those on warfarin therapy, the quality of anticoagulation has been poor in Chinese (and other Asian) patients even in the setting of randomized clinical trials. 11,12 The time in therapeutic range (TTR), reflecting the proportion of time spent within therapeutic range of 2.0 to 3.0, has emerged as a marker reflecting the quality of anticoagulation control while on warfarin therapy.…”

Clinical and Economic Implications of Apixaban Versus Aspirin in the Low-Risk Nonvalvular Atrial Fibrillation Patients

“…[33][34][35][36] For example, the estimated annual ischemic stroke risk for aspirin-treated patients with a CHA 2 DS 2 -VASc score of 1 used in this study was 1.37%, comparable, and in most cases, lower than estimates from nationwide cohort studies in untreated patients. [33][34][35][36] Given the range presented in the literature, it is unclear as to whether adjustment for this limitation could have led to any incremental changes in results and whether this would improve or worsen health gains for apixaban in either of the 2 CHA 2 DS 2 -VASc subgroups. Despite this uncertainty, aggregate results in the overall CHADS 2 =1 group of patients suggest that apixaban is a cost-effective alternative to aspirin at an ICER of $26 852 per QALY gained, which is below the lowest adopted threshold.…”