Should atrial fibrillation patients with 1 additional risk factor of the CHA2DS2-VASc score (beyond sex) receive oral anticoagulation?
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Background Although the CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score is recommended by both American and European guidelines for stroke risk stratification in atrial fibrillation (AF), the treatment recommendations for a CHA2DS2-VASc score of 1 are less clear.Objectives This study aimed to investigate the risk of ischemic stroke in patients with a single additional stroke risk factor (i.e., CHA2DS2-VASc score = 1 [males] or 2 [females]) and the impact of different component risk factors.Methods We used the National Health Insurance Research Database in Taiwan. Among 186,570 AF patients not on antiplatelet or anticoagulant therapy, we evaluated males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2. The clinical endpoint was the occurrence of ischemic stroke.Results Among 12,935 male AF patients with a CHA2DS2-VASc score of 1, 1,858 patients (14.4%) experienced ischemic stroke during follow-up (5.2 ± 4.3 years), with an annual stroke rate of 2.75%. Ischemic stroke risk ranged from 1.96%/year for men with vascular disease to 3.50%/year for those 65 to 74 years of age. For 7,900 females with AF and a CHA2DS2-VASc score of 2, 14.9% experienced ischemic stroke for an annual stroke rate of 2.55%. Ischemic stroke risk increased from 1.91%/year for women with hypertension to 3.34%/year for those 65 to 74 years of age.Conclusions Not all risk factors in CHA2DS2-VASc score carry an equal risk, with age 65 to 74 years associated with the highest stroke rate. Oral anticoagulation should be considered for AF patients with 1 additional stroke risk factor given their high risk of ischemic stroke.
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In many patients with one clinical risk factor (CHA2DS2-VASc score of 1 for men, and 2 for women), anticoagulation seems to provide a clinical benefit.
“In many of these patients, anticoagulation seems to provide a clinical benefit.[371][372][373][374][375]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [372]
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Stroke Prevention in Atrial Fibrillation: Focus on Asian Patients
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Age Threshold for Ischemic Stroke Risk in Atrial Fibrillation
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The risks of risk scores for stroke risk assessment in atrial fibrillation
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Registries in Atrial Fibrillation: From Trials to Real-Life Clinical Practice
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Guideline-Adherent Antithrombotic Treatment Improves Outcomes in Patients With Atrial Fibrillation
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Pre-Diabetes Increases Stroke Risk in Patients With Nonvalvular Atrial Fibrillation
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- Authors
- Chao, T.-F., Liu, C.-J., Wang, K.-L., Lin, Y.-J., Chang, S.-L., Lo, L.-W., Hu, Y.-F., Tuan, T.-C., Chen, T.-J., Lip, G. Y. H., & Chen, S.-A.
- Affiliations
- Taipei Veterans General Hospital (TW)
- Birmingham City Hospital (GB)
- Corresponding author
- Chen, Shih-Ann
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 65
- Issue
- 7
- Pages
- 635-642
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2022880742
- Cited by
- 258
- References
- 43
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 16 · 2023: 8 · 2022: 9 · 2021: 18 · 2020: 24 · 2019: 30 · 2018: 40 · 2017: 28 · 2016: 46 · 2015: 24
- FWCI
- 33.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- National Science Council (NSC98-2410-H-010-003-MY2)
- Taipei Veterans General Hospital (V100D-002-3, V101D-001-2, V102B-025, V99A-153, V99C1-140)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- atrial fibrillation, CHA2DS2-VASc score, oral anticoagulation, ischemic stroke risk, stroke risk stratification, sex differences, hypertension, vascular disease, diabetes mellitus, congestive heart failure
- MeSH terms
- Administration, Oral, Age Factors, Aged, Anticoagulants, Atrial Fibrillation, Ischemic Attack, Transient, Female, Humans, Hypertension, Male, Middle Aged, Retrospective Studies, Risk Factors, Sex Factors, Taiwan, Risk Assessment, Stroke, Diabetes Complications
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