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)open access
- Authors
- Jung, Moonki; Byeon, Kyeongmin; Kang, Ki-Woon; Lee, Wang-Soo; Kim, Sang Wook; Park, Yae Min; Hwang, You Mi; Lee, Sung Ho; Jin, Eun-Sun; Roh, Seung-Young; Kim, Jin Seok; Ahn, Jinhee; Lee, So-Ryoung; Choi, Eue-Keun; Ahn, Min-Soo; Lee, Eun Mi; Park, Hwan-Cheol; Lee, Ki Hong; Kim, Min; Choi, Joon Hyouk; Ko, Jum Suk; Kim, Jin Bae; Kim, Changsoo; Lip, Gregory Y. H.; Shin, Seung Yong
- Issue Date
- Jun-2023
- Publisher
- Elsevier BV
- Keywords
- ABCD score; antithrombotic treatment; atrial fibrillation; net clinical benefit; non-vitamin K antagonist oral anticoagulant
- Citation
- Journal of Arrhythmia, v.39, no.3, pp 376 - 387
- Pages
- 12
- Indexed
- SCOPUS
ESCI
- Journal Title
- Journal of Arrhythmia
- Volume
- 39
- Number
- 3
- Start Page
- 376
- End Page
- 387
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/62760
- DOI
- 10.1002/joa3.12840
- ISSN
- 1880-4276
1883-2148
- 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.
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Collections - 2. Clinical Science > Department of Cardiology > 1. Journal Articles
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