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Net clinical benefit of oral anticoagulants in Korean atrial fibrillation patients with low to intermediate stroke risk: A report from the Clinical Survey on Stroke Prevention in patients with Atrial Fibrillation (CS‐SPAF).
- Source :
- Journal of Arrhythmia; Jun2023, Vol. 39 Issue 3, p376-387, 12p
- Publication Year :
- 2023
-
Abstract
- Background: The balance of stroke risk reduction and potential bleeding risk associated with antithrombotic treatment (ATT) remains unclear in atrial fibrillation (AF) at non‐gender CHA2DS2‐VASc scores 0–1. A net clinical benefit (NCB) analysis of ATT may guide stroke prevention strategies in AF with non‐gender CHA2DS2‐VASc scores 0–1. Methods: This multi‐center cohort study evaluated the clinical outcomes of treatment with a single antiplatelet (SAPT), vitamin K antagonist (VKA), and non‐VKA oral anticoagulant (NOAC) in non‐gender CHA2DS2‐VASc score 0–1 and further stratified by biomarker‐based ABCD score (Age [≥60 years], B‐type natriuretic peptide [BNP] or N‐terminal pro‐BNP [≥300 pg/mL], creatinine clearance [<50 mL/min], and dimension of the left atrium [≥45 mm]). The primary outcome was the NCB of ATT, including composite thrombotic events (ischemic stroke, systemic embolism, and myocardial infarction) and major bleeding events. Results: We included 2465 patients (age 56.2 ± 9.5 years; female 27.0%) followed‐up for 4.0 ± 2.8 years, of whom 661 (26.8%) were treated with SAPT; 423 (17.2%) with VKA; and 1040 (42.2%) with NOAC. With detailed risk stratification using the ABCD score, NOAC showed a significant positive NCB compared with the other ATTs (SAPT vs. NOAC, NCB 2.01, 95% confidence interval [CI] 0.37–4.66; VKA vs. NOAC, NCB 2.38, 95% CI 0.56–5.40) in ABCD score ≥1. ATT failed to show a positive NCB in patients with truly low stroke risk (ABCD score = 0). Conclusions: In the Korean AF cohort at non‐gender CHA2DS2‐VASc scores 0–1, NOAC showed significant NCB advantages over VKA or SAPT with ABCD score ≥1. [ABSTRACT FROM AUTHOR]
- Subjects :
- STROKE prevention
HEMORRHAGE risk factors
ANTICOAGULANTS
RISK assessment
RESEARCH funding
ORAL drug administration
FIBRINOLYTIC agents
VITAMIN K
TREATMENT effectiveness
PEPTIDE hormones
DESCRIPTIVE statistics
SURVEYS
LONGITUDINAL method
ATRIAL fibrillation
RESEARCH
STROKE
PLATELET aggregation inhibitors
CONFIDENCE intervals
DATA analysis software
BIOMARKERS
DISEASE risk factors
CHEMICAL inhibitors
Subjects
Details
- Language :
- English
- ISSN :
- 18832148
- Volume :
- 39
- Issue :
- 3
- Database :
- Supplemental Index
- Journal :
- Journal of Arrhythmia
- Publication Type :
- Academic Journal
- Accession number :
- 164306392
- Full Text :
- https://doi.org/10.1002/joa3.12840