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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
Abstract
Oral 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…
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“The rates of stroke and thromboembolism vary considerably in patients with CHA 2 DS 2 -VASc scores of 1 or 2 due to differences in outcomes, populations, and anticoagulation status (Web Addenda Table 1).371,376,377,1041”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [377]
Citations
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“Importantly, we should not forget that OAC also reduces all cause mortality in AF patients, compared to placebo/control (1).”
Background2012 focused update of the ESC Guidelines for the management of atrial fibrillation
Authors Task Force Members, Camm, A. J., Lip, G. Y. H., Caterina, R. D., Savelieva, I., Atar, D., Hohnloser, S. H., Hindricks, G., Kirchhof, P. F., Bax, J. J., et al. (2012) · EP Europace · doi:10.1093/europace/eus305 · Cited by 3,823
Self-citation2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
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Self-citationThe Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation
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“5 %/year, sufficient to recommend that OAC should be considered (9-12).”
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“The present study is an extended analysis of the one-year NCB data for patients with one stroke risk factor, previously published (10, 13).”
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Self-citationPatient outcomes using the European label for dabigatran
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Self-citationStroke risk in atrial fibrillation: Do we anticoagulate CHADS2 or CHA2DS2-VASc ≥1, or higher?
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- 10.1161/CIRCULATIONAHA.111.055079 · DOI · Paper page
- 10.1160/TH11-05-0364 · DOI · Paper page
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P. F., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castellà, M., Diener, H., Heidbüchel, H., Hendriks, J., et al. (2016) · EP Europace · doi:10.1093/europace/euw295 · Cited by 6,438
Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418
“– 375 The rates of stroke and thrombo-embolism vary considerably in patients with CHA2DS2VASc scores of 1 or 2 due to differences in outcomes, populations, and anticoagulation status (Web Table 1).(371,376,377,1041) We therefore commissioned an analysis of stroke risk in men and women”
Self-citationCollet, J.-P., Thiele, H., Barbato, E., Barthélémy, O., Bauersachs, J., Bhatt, D. L., Dendale, P., Dorobantu, M., Edvardsen, T., Folliguet, T., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehaa575 · Cited by 5,037
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezw313 · Cited by 1,403
Self-citationStroke prevention in atrial fibrillation
Freedman, B., Potpara, T., & Lip, G. Y. H. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31257-0 · Cited by 484
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Metadata
- Authors
- Skjøth, F., Nielsen, P., Larsen, T. B., & Lip, G.
- Affiliations
- Birmingham City Hospital (GB)
- Aalborg University Hospital (DK)
- Corresponding author
- Lip, Gregory
- Venue
- Thrombosis and Haemostasis
- Publisher
- Georg Thieme Verlag KG
- Published
- 2015
- Volume
- 114
- Issue
- 10
- Pages
- 826-834
- ISSN
- 0340-6245 (ISSN-L)
- 2567-689X
- OpenAlex
- W2160740406
- Cited by
- 106
- References
- 30
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 9 · 2020: 7 · 2019: 9 · 2018: 11 · 2017: 15 · 2016: 39 · 2015: 4
- FWCI
- 16.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thrombosis and Haemostasis (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- 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, oral anticoagulation, warfarin, aspirin, stroke prevention, intracranial hemorrhage, bleeding risk, net clinical benefit
- MeSH terms
- Administration, Oral, Aged, Aged, 80 and over, Aspirin, Atrial Fibrillation, Decision Support Techniques, Denmark, Female, Fibrinolytic Agents, Hemorrhage, Humans, Male, Middle Aged, Predictive Value of Tests, Registries, Risk Factors, Time Factors, Warfarin, Treatment Outcome, Risk Assessment, Patient Selection, Stroke
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