Should Every Patient With Atrial Fibrillation and a CHA2DS2-VASc Score of 1 Be Anticoagulated? A Systematic Review of 37,030 Patients

Patients with atrial fibrillation (AF) are at risk of thromboembolic events. The CHA2DS2-VASc (congestive heart failure, hypertension, age 65–74, diabetes, female sex and vascular disease, which all count for 1 point, and previous transient ischemic stroke/stroke or age ≥ 75 years, which count for two points) score stratifies this risk and consequently indicates whether anticoagulation is required but leaves room for debate regarding patients with a CHA2DS2-VASc score of 1, irrespective of sex. A score of 1, irrespective of sex, is derived from varying risk factors and may represent different risks. We systematically searched PubMed from inception to July 31, 2017, for studies describing thromboembolic risk per risk factor of the CHA2DS2-VASc score in patients with AF not treated with an anticoagulant. Two independent reviewers selected, appraised, and extracted the data to determine the thromboembolic risk per risk factor. Per study, risk factors were ranked for highest through lowest risk. Five studies were included, comprising 37,030 subjects with a CHA2DS2-VASc score of 1. Numerically, the highest event rates were seen in patients without comorbidities, but aged 65–74 years, while event rates in patients with vascular disease tended to be the lowest. Age 65–74 years is associated with the highest risk, hazard ratios ranging from 1.9 (95% confidence interval, 1.7–2.1) to 3.9 (95% confidence interval, 2.3–6.6), while comorbid cardiovascular ...
Source: Cardiology in Review - Category: Cardiology Tags: Review Articles Source Type: research

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Int J Angiol DOI: 10.1055/s-0040-1708477Atrial fibrillation (AF), the most prevalent arrhythmic disease, tends to foster thrombus formation due to hemodynamic disturbances, leading to severe disabling and even fatal thromboembolic diseases. Meanwhile, patients with AF may also present with acute coronary syndrome (ACS) and coronary artery disease (CAD) requiring stenting, which creates a clinical dilemma considering that majority of such patients will likely receive oral anticoagulants (OACs) for stroke prevention and require additional double antiplatelet treatment (DAPT) to reduce recurrent cardiac events and in-stent th...
Source: International Journal of Angiology - Category: Cardiology Authors: Tags: Invited Papers Source Type: research
Anticoagulation for prevention of stroke is a well established modality of treatment in atrial fibrillation. But a significant number of them have bleeding complications. Hence the option of left atrial appendage closure with multiple types of devices have been developed. Left atrial appendage with its sluggish flow is the most common location for thrombus formation in atrial fibrillation. Following devices have been used with varying success: Watchman Amplatzer Cardiac Plug/Amulet Lariat suture ligation Atriclip PROTECT-AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillatio...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology Source Type: blogs
AbstractAtrial fibrillation is the most common arrhythmia and its prevalence is expected to further increase. Patients with atrial fibrillation have an increased risk of stroke (fivefold increased risk), heart failure, and death. In patients with non-valvular atrial fibrillation, the most recent guidelines recommend the use of the CHA2DS2-VASc (congestive heart failure, arterial hypertension, age  >  75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65–74 years, sex category) scoring system to identify those who may benefit from oral anticoagulant treatmen...
Source: Internal and Emergency Medicine - Category: Emergency Medicine Source Type: research
Abstract BACKGROUND AND OBJECTIVES: The aim of this retrospective cohort study was to develop a new score (RA-CHADSV) (rheumatoid arthritis - congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, and vascular disease), modified from the CHA2DS2-VASc score (congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, stroke/transient ischemic attack (doubled), vascular disease, age 65-74 years, and female), in predicting the risk of ischemic stroke in rheumatoid arthritis (RA) patients without atrial fibrillation (AF)...
Source: Medicina (Kaunas) - Category: Universities & Medical Training Authors: Tags: Medicina (Kaunas) Source Type: research
To examine the role of the CHA2DS2-VASc (Congestive heart failure; Hypertension; Age ≥75 years [doubled]; Diabetes; previous Stroke, transient ischemic attack, or thromboembolism [doubled]; Vascular disease; Age 65-75 years; and Sex category) score as a prognostic marker of in-hospital mortality in critically ill patients who develop new-onset atrial fibrillation (NOAF).
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research
Publication date: May 2019Source: Canadian Journal of Cardiology, Volume 35, Issue 5Author(s): Błażej Głowicki, Paweł T. Matusik, Krzysztof Plens, Anetta UndasAbstractBackgroundIt is unclear whether a prothrombotic state occurs in atrial fibrillation (AF) with low stroke risk.MethodsWe studied 118 patients with AF with the Congestive Heart Failure, Hypertension, Age (≥ 75 years), Diabetes, Stroke/Transient Ischemic Attack/Systemic Embolism, Vascular Disease, Age (65-74 years), Sex (Female) (CHA2DS2-VASc) score of 1 in men or 2 in women vs 52 patients with AF with the CHA2DS2-VASc score of 0 in men or 1 in women. Pla...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
CONCLUSION: The results of the study show that the VVI-derived LAA strain rate is a significant predictor of documented ischemic stroke and systemic thromboembolism in patients with nonvalvular atrial fibrillation. Its predictive power is similar to the predictive power of the CHA2DS2-VASc score. PMID: 30824998 [PubMed - as supplied by publisher]
Source: Wiener Klinische Wochenschrift - Category: General Medicine Authors: Tags: Wien Klin Wochenschr Source Type: research
AbstractPurposePatients with atrial fibrillation (AF) undergoing cardiac surgery are at substantially increased risk for stroke. Increasing evidence has suggested that surgical left atrial appendage occlusion (S-LAAO) may have the potential to substantially mitigate this stroke risk; however, S-LAAO is performed in a minority of patients with AF undergoing cardiac surgery. We sought to identify factors associated with usage of S-LAAO.MethodsIn a nationally-representative, contemporary cohort (07/2011 –06/2012) of older patients undergoing cardiac surgery with preoperative AF (n = 11,404) from the Medica...
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
This study investigated the CHA2DS2-VASc score to stratify patients with cardiovascular diseases receiving a fourth-generation synchronous telehealth program. Methods: This was a retrospective cohort study. We recruited patients with cardiovascular disease who received the fourth-generation synchronous telehealth program at the National Taiwan University Hospital between October 2012 and June 2015. We enrolled 431 patients who had joined a telehealth program and compared them to 1549 control patients. Risk of cardiovascular hospitalization was estimated with Kaplan-Meier curves. The CHA2DS2-VASc score was used as the compo...
Source: Journal of Medical Internet Research - Category: General Medicine Authors: Source Type: research
ConclusionsPhysicians should pay more attention to manageable risk factors of ischemic stroke when diabetic patients suffer from ocular motor CN palsies.
Source: Journal of Diabetes - Category: Endocrinology Authors: Tags: ORIGINAL ARTICLE Source Type: research
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