Cited by 258Atrial Fibrillation Management and OutcomesAcute Ischemic Stroke ManagementVenous Thromboembolism Diagnosis and Management

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Should Atrial Fibrillation Patients With 1 Additional Risk Factor of the CHA2DS2-VASc Score (Beyond Sex) Receive Oral Anticoagulation?

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Chao, Tze-Fan, Liu, Chia-Jen, Wang, Kang-Ling, Lin, Yenn-Jiang, Chang, Shih-Lin, Lo, Li-Wei, Hu, Yu-Feng, Tuan, Ta-Chuan, Chen, Tzeng-Ji, Lip, Gregory Y.H., Chen, Shih-Ann·2015·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2014.11.046

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Abstract

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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Comparing the Effectiveness and Safety of Nonvitamin K Antagonist Oral Anticoagulants and Warfarin in Elderly Asian Patients With Atrial Fibrillation
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“Previous studies have also suggested that the non-sex risk factors of the CHA2DS2-VASc score allotted 1 point do not carry equal risk of stroke, and that age 65 to 74 years is associated with higher risk of stroke than the other risk factors allotted 1 point.(14,18) The current European AF guidelines emphasize that OA…”
Background
Stroke and bleeding risk in atrial fibrillation with CHA2DS2-VASC risk score of one: the Norwegian AFNOR study
Anjum, M., Ariansen, I., Hjellvik, V., Selmer, R. M., Kjerpeseth, L. J., Skovlund, E., Myrstad, M., Ellekjær, H., Christophersen, I. E., Tveit, A., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad659 · Cited by 41
Guideline-Adherent Antithrombotic Treatment Improves Outcomes in Patients With Atrial Fibrillation
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Patel, S. M., D, E. B. M., Steffel, J., Boriani, G., Palazzolo, M. G., Antman, E. M., Bohula, E. A., Carnicelli, A., Connolly, S. J., Eikelboom, J. W., et al. (2024) · Circulation · doi:10.1161/circulationaha.123.066279 · Cited by 33
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Camm, A. J., Savelieva, I., Potpara, T., Hindriks, G., Pison, L., & Blomström‐Lundqvist, C. (2016) · Journal of Internal Medicine · doi:10.1111/joim.12478 · Cited by 30
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“Thus, the focus should be drawn on the truly low-risk patients and those with one additional risk factor (CHA2DS2-VASc score of 1 in male, 2 in female), where anticoagulation is also likely to benefit [27, 28].”
Background
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Yamagishi, S. (2019) · Cardiovascular Diabetology · doi:10.1186/s12933-019-0818-0 · Cited by 29
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Pre-Diabetes Increases Stroke Risk in Patients With Nonvalvular Atrial Fibrillation
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Should oral anticoagulants still be prescribed to patients with atrial fibrillation with a single stroke risk factor but at high bleeding risk? A nationwide cohort study
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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: Chao, Tze-Fan
Liu, Chia-Jen
Lin, Yenn-Jiang
Chang, Shih-Lin
Lo, Li-Wei
Hu, Yu-Feng
Tuan, Ta-Chuan
Chen, Tzeng-Ji
Lip, Gregory Y.H.
Chen, Shih-Ann
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)
DOI: 10.1016/j.jacc.2014.11.046
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 388 d)
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 › Clinical Neurology › 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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Should Atrial Fibrillation Patients With 1 Additional Risk Factor of the CHA2DS2-VASc Score (Beyond Sex) Receive Oral Anticoagulation?

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