Non-valvular atrial fibrillation patients with none or one additional risk factor of the CHA2DS2-VASc score:a comprehensive net clinical benefit analysis for warfarin, aspirin, or no therapy
| Autor: | Gregory Y.H. Lip, Peter Brønnum Nielsen, Flemming Skjøth, Torben Larsen |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Denmark Administration Oral Hemorrhage 030204 cardiovascular system & hematology Risk Assessment Decision Support Techniques 03 medical and health sciences 0302 clinical medicine Fibrinolytic Agents Predictive Value of Tests Risk Factors Internal medicine Atrial Fibrillation medicine Humans Registries cardiovascular diseases 030212 general & internal medicine Risk factor Stroke Aged Aged 80 and over Aspirin business.industry Patient Selection Warfarin Atrial fibrillation Hematology Middle Aged medicine.disease Surgery Treatment Outcome CHA2DS2–VASc score Female Risk assessment business Fibrinolytic agent medicine.drug |
| Zdroj: | Lip, G Y H, Skjøth, F, Nielsen, P B & Larsen, T B 2015, ' Non-valvular atrial fibrillation patients with none or one additional risk factor of the CHA2DS2-VASc score : a comprehensive net clinical benefit analysis for warfarin, aspirin, or no therapy ', Thrombosis and Haemostasis, vol. 114, no. 4, pp. 826-834 . https://doi.org/10.1160/TH15-07-0565 |
| DOI: | 10.1160/TH15-07-0565 |
| Popis: | SummaryOral anticoagulation (OAC) to prevent stroke has to be balanced against the potential harm of serious bleeding, especially intracranial haemorrhage (ICH). We determined the net clinical benefit (NCB) balancing effectiveness and safety of no antithrombotic therapy, aspirin and warfarin in AF patients with none or one stroke risk factor. Using Danish registries, we determined NCB using various definitions intrinsic to our cohort (Danish weights at 1 and 5 year follow-up), with risk weights which were derived from the hazard ratio (HR) of death following an event, relative to HR of death after ischaemic stroke. When aspirin was compared to no treatment, NCB was neutral or negative for both risk strata. For warfarin vs no treatment, NCB using Danish weights was neutral where no risk factors were present and using five years follow-up. For one stroke risk factor, NCB was positive for warfarin vs no treatment, for one year and five year follow-up. For warfarin vs aspirin use in patients with no risk factors, NCB was positive with one year follow-up, but neutral with five year follow-up. With one risk factor, NCB was generally positive for warfarin vs aspirin. In conclusion, we show a positive overall advantage (i.e. positive NCB) of effective stroke prevention with OAC, compared to no therapy or aspirin with one additional stroke risk factor, using Danish weights. ‘Low risk’ AF patients with no additional stroke risk factors (i.e. CHA2DS2-VASc 0 in males, 1 in females) do not derive any advantage (neutral or negative NCB) with aspirin, nor with warfarin therapy in the long run.Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief. |
| Databáze: | OpenAIRE |
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