The DOI matches its Crossref record; 26 of the 26 references it cites were found in a registry or an index.
Oral Anticoagulation, Aspirin, or No Therapy in Patients With Nonvalvular AF With 0 or 1 Stroke Risk Factor Based on the CHA2DS2-VASc Score
Open accessAbstract
Background Even a single additional stroke risk factor in patients with atrial fibrillation may confer a risk of stroke. However, there is no consensus on how best to treat these patients.Objectives Our objective was to investigate the risk of stroke and bleeding and the impact of antithrombotic therapy among low-risk patients, i.e., with 0 or 1 CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65 to 74 years, sex category) score risk factor.Methods The nationwide cohort for this study was established by linking data from the Danish Civil Registration System, the Danish National Patient Register, and the Danish National Prescription Registry. We studied 39,400 patients discharged with incident nonvalvular atrial fibrillation with 0 or 1 CHA2DS2-VASc risk factor; 23,572 were not treated, 5,353 were initiated on aspirin, and 10,475 were initiated on warfarin.Results Stroke event rates for untreated low-risk patients (CHA2DS2-VASc = 0 [male], 1 [female]) were 0.49 per 100 person-years at 1 year and 0.47 per 100 person-years at full follow-up (intention-to-treat). Bleeding event rates among untreated low-risk patients were 1.08 per 100 person-years at 1 year and 0.97 at full follow-up. The presence of 1 additional stroke risk factor (CHA2DS2-VASc = 1 [male], = 2 [female]) among untreated patients increased the stroke rate at 1 year to 1.55 per 100 person-years, representing a significant 3.01-fold increase. At the 1-year follow-up, bleeding increased 2.35-fold, and death increased 3.12-fold.Conclusions Low-risk patients (CHA2DS2-VASc = 0 [male], 1 [female]) have a truly low risk for stroke and bleeding. With 1 additional stroke risk factor (CHA2DS2-VASc = 1 [male], = 2 [female]), there was a significant increase in event rates (particularly mortality) if nonanticoagulated.
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“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 [373]
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Metadata
- Authors
- Lip, G. Y. H., Skjøth, F., Rasmussen, L. H., & Larsen, T. B.
- Affiliations
- Birmingham City Hospital (GB)
- Aalborg University Hospital (DK)
- Aalborg University (DK)
- Corresponding author
- Lip, Gregory Y.H.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-04
- Volume
- 65
- Issue
- 14
- Pages
- 1385-1394
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2161837371
- Cited by
- 171
- References
- 26
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 9 · 2023: 9 · 2022: 5 · 2021: 9 · 2020: 7 · 2019: 17 · 2018: 16 · 2017: 21 · 2016: 43 · 2015: 24
- FWCI
- 25.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Funders
- AstraZeneca
- Sanofi
- Astellas Pharma
- 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
- non-valvular atrial fibrillation, CHA2DS2-VASc score, stroke risk, bleeding risk, oral anticoagulation, warfarin, aspirin, antithrombotic therapy, low-risk patients, stroke prevention, mortality, sex differences, stroke risk factors, civil registration, patient registry, incident atrial fibrillation
- MeSH terms
- Administration, Oral, Aged, Anticoagulants, Aspirin, Atrial Fibrillation, Blood Coagulation, Denmark, Female, Humans, Male, Registries, Risk Factors, Cohort Studies, Stroke
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