Bleeding risk assessment and management in atrial fibrillation patientsLip GYH, Andreotti F, Fauchier L (2011) Bleeding risk assessment and management in atrial fibrillation patients: a position document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis. Europace 13(5): 723–746

2011 ◽  
Vol 6 (9) ◽  
pp. 440-442 ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
European Society ◽  
Working Group ◽  
Heart Rhythm ◽  
Bleeding Risk ◽  
European Society Of Cardiology ◽  
Risk Assessment And Management

Abstract 19336: Reported Stroke Rates in Patients With Nonvalvular Atrial Fibrillation in North America are Lower Than Those Cited in ESC and AHA Guidelines

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Gene R Quinn ◽  
Daniel E Singer
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Heart Association ◽  
Heart Rhythm ◽  
Bleeding Risk ◽  
Net Benefit ◽  
Nonvalvular Atrial Fibrillation ◽  
Score Threshold ◽  
Esc Guidelines ◽  
European Society Of Cardiology

Background: Anticoagulants (OAC) decrease ischemic stroke rates in patients with atrial fibrillation (AF) but increase the risk of bleeding. The risk of ischemic stroke where the absolute benefit of anticoagulation outweighs the bleeding risk has been shown to be 1-2% per year. The American Heart Association/American College of Cardiology/Heart Rhythm Society and the European Society of Cardiology (ESC) guidelines have adopted the CHA2DS2-VASc stroke risk score; their recommendations assume the scheme’s point scores correspond to fixed stroke rates. However, reported rates of stroke vary widely across cohorts, placing in question the generalizability of guideline recommendations. Objective: To contrast the reported rates of stroke in North American (NA) patients with AF who do not take OAC with the Danish AF cohort used to create the ESC guidelines. Methods: We conducted a systematic review to identify all cohort studies and randomized controlled trials including patients with non-valvular AF not treated with OAC. We excluded studies that enrolled only patients undergoing surgical procedures or cardioversion, or only patients with specific comorbidities such as prior stroke or kidney disease. Results: Of the 3,552 studies screened, we identified 13 eligible NA studies representing 137,652 patients. Larger and more contemporary cohorts generally had lower stroke rates (Table). When weighted by number of subjects, the NA cohorts’ ischemic stroke rate averaged 1.88% per year, whereas the Danish cohort had a rate of 4.66% per year. Conclusions: Large variation exists in stroke rates across putatively representative cohorts. This may reflect true differences in rates or methodologic differences among studies. These differences could change the point score threshold for recommending OAC in lower risk regions. Reexamining the net benefit of OAC in patients with a CHA2DS2-VASc score of 1 or 2 seems warranted, particularly for those with weak 1-point risk factors.

scholarly journals Oral anticoagulation in patients with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1: a current opinion of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and European Society of Cardiology Council on Stroke

2019 ◽  
Vol 5 (3) ◽  
pp. 171-180 ◽  
Author(s):  
Patrick Sulzgruber ◽  
Sven Wassmann ◽  
Anne Grete Semb ◽  
Wolfram Doehner ◽  
Petr Widimsky ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
European Society ◽  
Oral Anticoagulation ◽  
Working Group ◽  
Thromboembolic Risk ◽  
Current Opinion ◽  
Cardiovascular Pharmacotherapy ◽  
Therapeutic Decisions ◽  
The Individual ◽  
European Society Of Cardiology

Abstract Oral anticoagulation in patients presenting with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1 (CHA2DS2-VASc of 2 in women) remains a challenging approach in clinical practice. Therapeutic decisions need to balance the individual benefit of reducing thromboembolic risk against the potential harm due to an increase in bleeding risk in this intermediate risk patient population. Within the current opinion statement of the European Society of Cardiology working group of cardiovascular pharmacotherapy and the European Society of Cardiology council on stroke the currently available evidence on the anti-thrombotic management in patients presenting with a CHA2DS2-VASc of 1 is summarized. Easily applicable tools for a personalized refinement of the individual thromboembolic risk in patients with atrial fibrillation and a CHA2DS2-VASc score of 1 that guide clinicians through the question whether to anticoagulate or not are provided.

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