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Anticoagulant therapy with warfarin or direct oral anticoagulants can reduce the mortality and severe morbidity of patients with atrial fibrillation (AF) who are at higher risk of stroke.
Most clinicians usually use CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, female) or CHADS2 score to determine the start of anticoagulant therapy in AF patients Threshold.
Yimaitong compiles and organizes, please do not reprint without authorization.
The American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) recommend that patients with a CHA2DS2-VASc score ≥2 for men or ≥3 for women undergo anticoagulation therapy, while the National Institutes of Health recommends that men and women Female patients with CHA2DS2-VASc score ≥2 were treated with anticoagulant therapy.
In contrast, the American College of Chest Physicians (ACCP) recommends that men with a CHA2DS2-VASc score ≥1 and women with a CHA2DS2-VASc score ≥2 for anticoagulation therapy, and the Canadian Cardiovascular Society recommends patients with a CHA2DS2-VASc score ≥1.
Get anticoagulant therapy.
The guidelines of the National Institute of Health and Care Optimization indicate that anticoagulation should be considered when the CHA2DS2-VASc score is 1, while the ESC and ACC/AHA guidelines recommend that when the CHA2DS2-VASc score is 1 for men and 2 for women, anticoagulation should be considered.
treatment.
For patients aged 65-74 who have no other risk factors for stroke, the recommendations of the various guidelines are not uniform.
Given that the current clinical trial data is limited and the recommendations of each guideline are not the same, the team of Professor Husam from Canada conducted an assessment of AF patients aged 66-74 and without other risk factors for CHA2DS2-VASc who are not receiving anticoagulation therapy The study of the risk of stroke in the case of, and explored the relationship between the incidence of stroke and the age of the patient.
Research Introduction The researchers used the relevant administrative database to conduct a population-based retrospective cohort study.
This population includes 16,351 patients between the ages of 66 and 74 who were newly diagnosed with AF in Ontario, Canada from April 1, 2007 to March 31, 2017.
The researchers used the cumulative incidence function to estimate the incidence of stroke in patients who did not receive anticoagulation therapy within 1 year.
Fine-Gray regression was used to study the relationship between patient characteristics and stroke incidence, and to derive stroke risk estimates for each age group.
The main result of this study was that patients were hospitalized for stroke.
Cerebral hemorrhage was included in this outcome definition because it occurred in AF patients who did not receive anticoagulation therapy, which may represent a hemorrhagic transformation of cardiogenic stroke.
The standard of "stroke hospitalization" may underestimate the incidence of severe stroke.
Because patients may have died before hospitalization, the researchers also studied the composite outcome of stroke or death from any cerebrovascular disease.
Main findings: ➤Among 16,351 patients with AF (median [interquartile range] age, 70[68-72] years), 8,352 (51.
1%) were male; of these, 6,314 (38.
6%) were in follow-up Anticoagulant therapy was started during this period.
The overall incidence of stroke within 1 year of patients who did not receive anticoagulation therapy was 1.
1% (95% CI: 1.
0%-1.
3%), and the incidence of death without stroke was 8.
1% (95% CI: 7.
7%-8.
5%).
➤The only baseline feature that is significantly associated with a higher incidence of stroke is the age of the patient.
As the patient’s age increases, the estimated risk of stroke within 1 year increases from 66 years (0.
7%; 95% CI: 0.
5%-0.
9%) to 74 years (1.
7%; 95% CI: 1.
3%-2.
1%).
However, the incidence of stroke has no obvious relationship with gender.
Conclusion This population-based observational cohort study aims to assess the risk of stroke in AF patients aged 66-74 years and without other CHA2DS2-VASc risk factors without anticoagulation therapy.
In the entire cohort study, the risk of stroke within 1 year for patients who did not receive anticoagulation treatment was estimated to be 1.
1% (95% CI: 1.
0%-1.
3%), and the risk of stroke within 1 year for patients less than 70 years old was 0.
7% (95%).
% CI: 0.
6%-0.
9%).
As the patient’s age increased from 66 to 74 years, the estimated risk of stroke within 1 year without anticoagulant therapy more than doubled, but there was no difference in gender.
These findings indicate that anticoagulation therapy is more likely to benefit these elderly patients, while younger patients are less likely to obtain a net clinical benefit from anticoagulation therapy.
Original Index: Abdel-Qadir H, Singh SM, Pang A, Austin PC, Jackevicius CA, Tu K, Dorian P, Ko DT.
Evaluation of the Risk of Stroke Without Anticoagulation Therapy in Men and Women With Atrial Fibrillation Aged 66 to 74 Years Without Other CHA2DS2-VASc Factors.
JAMA Cardiol.
2021 May 19.
doi: 10.
1001/jamacardio.
2021.
1232.
Epub ahead of print.
PMID: 34009232.
Most clinicians usually use CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, female) or CHADS2 score to determine the start of anticoagulant therapy in AF patients Threshold.
Yimaitong compiles and organizes, please do not reprint without authorization.
The American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) recommend that patients with a CHA2DS2-VASc score ≥2 for men or ≥3 for women undergo anticoagulation therapy, while the National Institutes of Health recommends that men and women Female patients with CHA2DS2-VASc score ≥2 were treated with anticoagulant therapy.
In contrast, the American College of Chest Physicians (ACCP) recommends that men with a CHA2DS2-VASc score ≥1 and women with a CHA2DS2-VASc score ≥2 for anticoagulation therapy, and the Canadian Cardiovascular Society recommends patients with a CHA2DS2-VASc score ≥1.
Get anticoagulant therapy.
The guidelines of the National Institute of Health and Care Optimization indicate that anticoagulation should be considered when the CHA2DS2-VASc score is 1, while the ESC and ACC/AHA guidelines recommend that when the CHA2DS2-VASc score is 1 for men and 2 for women, anticoagulation should be considered.
treatment.
For patients aged 65-74 who have no other risk factors for stroke, the recommendations of the various guidelines are not uniform.
Given that the current clinical trial data is limited and the recommendations of each guideline are not the same, the team of Professor Husam from Canada conducted an assessment of AF patients aged 66-74 and without other risk factors for CHA2DS2-VASc who are not receiving anticoagulation therapy The study of the risk of stroke in the case of, and explored the relationship between the incidence of stroke and the age of the patient.
Research Introduction The researchers used the relevant administrative database to conduct a population-based retrospective cohort study.
This population includes 16,351 patients between the ages of 66 and 74 who were newly diagnosed with AF in Ontario, Canada from April 1, 2007 to March 31, 2017.
The researchers used the cumulative incidence function to estimate the incidence of stroke in patients who did not receive anticoagulation therapy within 1 year.
Fine-Gray regression was used to study the relationship between patient characteristics and stroke incidence, and to derive stroke risk estimates for each age group.
The main result of this study was that patients were hospitalized for stroke.
Cerebral hemorrhage was included in this outcome definition because it occurred in AF patients who did not receive anticoagulation therapy, which may represent a hemorrhagic transformation of cardiogenic stroke.
The standard of "stroke hospitalization" may underestimate the incidence of severe stroke.
Because patients may have died before hospitalization, the researchers also studied the composite outcome of stroke or death from any cerebrovascular disease.
Main findings: ➤Among 16,351 patients with AF (median [interquartile range] age, 70[68-72] years), 8,352 (51.
1%) were male; of these, 6,314 (38.
6%) were in follow-up Anticoagulant therapy was started during this period.
The overall incidence of stroke within 1 year of patients who did not receive anticoagulation therapy was 1.
1% (95% CI: 1.
0%-1.
3%), and the incidence of death without stroke was 8.
1% (95% CI: 7.
7%-8.
5%).
➤The only baseline feature that is significantly associated with a higher incidence of stroke is the age of the patient.
As the patient’s age increases, the estimated risk of stroke within 1 year increases from 66 years (0.
7%; 95% CI: 0.
5%-0.
9%) to 74 years (1.
7%; 95% CI: 1.
3%-2.
1%).
However, the incidence of stroke has no obvious relationship with gender.
Conclusion This population-based observational cohort study aims to assess the risk of stroke in AF patients aged 66-74 years and without other CHA2DS2-VASc risk factors without anticoagulation therapy.
In the entire cohort study, the risk of stroke within 1 year for patients who did not receive anticoagulation treatment was estimated to be 1.
1% (95% CI: 1.
0%-1.
3%), and the risk of stroke within 1 year for patients less than 70 years old was 0.
7% (95%).
% CI: 0.
6%-0.
9%).
As the patient’s age increased from 66 to 74 years, the estimated risk of stroke within 1 year without anticoagulant therapy more than doubled, but there was no difference in gender.
These findings indicate that anticoagulation therapy is more likely to benefit these elderly patients, while younger patients are less likely to obtain a net clinical benefit from anticoagulation therapy.
Original Index: Abdel-Qadir H, Singh SM, Pang A, Austin PC, Jackevicius CA, Tu K, Dorian P, Ko DT.
Evaluation of the Risk of Stroke Without Anticoagulation Therapy in Men and Women With Atrial Fibrillation Aged 66 to 74 Years Without Other CHA2DS2-VASc Factors.
JAMA Cardiol.
2021 May 19.
doi: 10.
1001/jamacardio.
2021.
1232.
Epub ahead of print.
PMID: 34009232.
