Net Clinical Benefit for Oral Anticoagulation, Aspirin, or No Therapy in Nonvalvular Atrial Fibrillation Patients With 1 Additional Risk Factor of the CHA2DS2-VASc Score (Beyond Sex)

摘要

Whether to anticoagulate patients with atrial fibrillation (AF) and 1 stroke risk factor (i.e., CHA2DS2-VASc [congestive heart failure, hypertension, age >75 years, diabetes mellitus, stroke, vascular disease, age 65-75 years, and female sex] score = 1 in rrien, or 2 in women) is controversial, but many studies report ischemic stroke rates of >l.5% per year, even with 1 stroke risk factor (1). We estimated the net clinical benefit (NCB) of aspirin or warfarin compared with no antithrombotic therapy among such patients on the basis of a nationwide Danish cohort, with incident AF diagnosed between 1998 and 2012 (2). Men with a CHA2DS2-VASc score =￡ 1 and women with score # 2 at the date of discharge after diagnosis were excluded, as were patients who initiated non-vitamin K antagonist (VKA) oral anticoagulants (OACs), phenprocoumon, or who had warfarin or aspirin prescriptions between 4 and 12 months and before the date of AF diagnosis. Others were stratified according to: 1) no treatment, if there was no prescription for warfarin or aspirin within 1 year; 2) aspirin; or 3) warfarin prescriptions within 4 months.