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Thromb Haemost 2015; 114(04): 826-834
DOI: 10.1160/TH15-07-0565
Stroke, Systemic or Venous Thromboembolism
Schattauer GmbH

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
Gregory Y. H. Lip
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
2   University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
,
Flemming Skjøth
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
3   Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital, Aalborg, Denmark
,
Peter B. Nielsen
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
4   Department of Cardiology, AF Study group, Aalborg University Hospital, Aalborg, Denmark
,
Torben Bjerregaard Larsen
1   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
4   Department of Cardiology, AF Study group, Aalborg University Hospital, Aalborg, Denmark
› Author Affiliations
Further Information

Publication History

Received: 15 July 2015

Accepted after fast-track review and minor revision: 16 July 2015

Publication Date:
29 November 2017 (online)

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Summary

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 any advantage (neutral or negative NCB) with aspirin, nor with warfarin therapy in the long run.

Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief.

Keywords

Net clinical benefit - mortality - stroke - bleeding

 

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