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Gregory Y H Lip - One of the best experts on this subject based on the ideXlab platform.
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Prediction of Residual Stroke Risk in Anticoagulated Patients with Atrial Fibrillation: mCARS
'MDPI AG', 2021Co-Authors: Wern Yew Ding, Francisco Marin, Vanessa Roldan, José Miguel Rivera-caravaca, Christian Torp-pedersen, Gregory Y H LipAbstract:Our ability to evaluate residual stroke risk despite anticoagulation in atrial fibrillation (AF) is currently lacking. The Calculator of Absolute Stroke Risk (CARS) has been proposed to predict 1-year absolute stroke risk in non-anticoagulated patients. We aimed to determine whether a modified CARS (mCARS) may be used to assess the residual stroke risk in anticoagulated AF patients from ‘real-world’ and ‘clinical trial’ cohorts. We studied patient-level data of anticoagulated AF patients from the real-world Murcia AF Project and AMADEUS clinical trial. Individual mCARS were estimated for each patient. None of the patients were treated with non-vitamin K antagonist oral anticoagulants. The predicted residual stroke risk was compared to actual stroke risk. 3503 patients were included (2205 [62.9%] clinical trial and 1298 [37.1%] real-world). There was wide variation of CARS for each category of CHA2DS2-VASc Score in both cohorts. Average predicted residual stroke risk by mCARS (1.8 ± 1.8%) was identical to actual stroke risk (1.8% [95% CI, 1.3–2.4]) in the clinical trial, and broadly similar in the real-world (2.1 ± 1.9% vs. 2.4% [95% CI, 1.6–3.4]). AUCs of mCARS for prediction of stroke events in the clinical trial and real-world were 0.678 (95% CI, 0.598–0.758) and 0.712 [95% CI, 0.618–0.805], respectively. mCARS was able to refine stroke risk estimation for each point of the CHA2DS2-VASc Score in both cohorts. Personalised residual 1-year absolute stroke risk in anticoagulated AF patients may be estimated using mCARS, thereby allowing an assessment of the absolute risk reduction of treatment and facilitating a patient-centred approach in the management of AF. Such identification of patients with high residual stroke risk could help target more aggressive interventions and follow-up
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age threshold for the use of non vitamin k antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation insights into the optimal assessment of age and incident comorbidities
European Heart Journal, 2019Co-Authors: Gregory Y H Lip, Tzefan Chao, Yennjiang Lin, Shihlin Chang, Tachuan TuanAbstract:Aims The stroke risk of patients with atrial fibrillation (AF) is not static, since AF patients get older and accumulate more comorbidities after AF is diagnosed. Therefore, the stroke risk of AF patients given certain comorbidities in different age strata should ideally be analysed using an assessment which considers incident comorbidities and the actual age when ischaemic stroke occurred. The goal of the present study is to report the age treatment thresholds for the use of non-vitamin K antagonist oral anticoagulants (NOACs) for AF patients without or with only one comorbidity of the CHA2DS2-VASc Score, based on an ‘ideal method’ of stroke risk assessments. Methods and results The study cohort included 31 039 and 39 020 AF patients who did not have any or had only one risk factor comorbidity of the CHA2DS2-VASc Score except for age and sex. The risks of ischaemic stroke in each age strata for each comorbidities were analysed in three ways, as follows: (i) the conventional way (based on baseline risk factors and age), (ii) dynamic method (patients were censored when new comorbidities occurred), and (iii) an ideal method (patients were censored when new comorbidities occurred and the stroke risk was related to the actual age when stroke happened). The tipping point for the use of NOACs was set at a stroke risk of 0.9%/year. The overall risk of ischaemic stroke using the conventional way was overestimated compared to the dynamic or ideal assessment with the incidence rate ratio of 1.24 for patients with hypertension, 1.20 for heart failure, 1.37 for diabetes mellitus, and 1.38 for vascular diseases; all P-values <0.01. The risk of ischaemic stroke for each age strata was generally higher with the conventional or dynamic methods compared with the ideal assessment. With heart failure, the tipping point (age 35 years) of NOACs was similar, irrespective of methods used for stroke risk assessment. According to the results of ideal assessment, the age thresholds for the use of NOACs for patients with hypertension, diabetes mellitus, and vascular diseases were 50 years, 50 years, and 55 years, respectively. Conclusion Ischaemic stroke risk in AF is heterogeneous, depending on different risk factors with age being as an important driver of stroke risk. Age thresholds for the use of NOACs were different for AF patients having different single risk factors beyond sex despite the same CHA2DS2-VASc Score point (1 for males and 2 for females); that is, 35 years for heart failure, 50 years for hypertension or diabetes, and 55 years for vascular diseases.
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relation of the cha2ds2 vasc Score to risk of thrombotic and embolic stroke in community dwelling individuals without atrial fibrillation from the atherosclerosis risk in communities aric study
American Journal of Cardiology, 2019Co-Authors: Ryan J Koene, Gregory Y H Lip, Chadi M Alraies, Faye L Norby, Elsayed Z Soliman, Ankit Maheshwari, Alvaro Alonso, Lin Y ChenAbstract:Recent hospital-based cohort studies found the CHA2DS2-VASc Score to be associated with ischemic stroke in individuals without atrial fibrillation (AF). Our aim was to determine the distribution of embolic and thrombotic strokes and association with the CHA2DS2-VASc Score, among community-dwelling individuals without AF. We included participants from the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 4 (1996 to 1998) and had no previous AF, stroke, or anticoagulant use (n = 10,671). During follow-up through 2008, incident AF cases (n = 760) and participants who started warfarin were censored. Incident AF was ascertained from study electrocardiograms and hospital discharge diagnosis codes, and stroke was physician-adjudicated. After 10 years of follow-up, 280 ischemic strokes were identified, of which 146 were thrombotic and 57 embolic. The hazard ratios (95% confidence intervals [CI]) for thrombotic stroke were 1 (reference), 1.71 (1.13 to 2.59), 2.92 (1.91 to 4.45), 3.22 (1.70 to 6.11), and 1.25 (0.17 to 9.09), with CHA2DS2-VASc Scores of 0 to 1, 2, 3, 4, and ≥5, respectively. The hazard ratios (95% CI) for embolic stroke were 1 (ref), 4.91 (2.10 to 11.5), 7.07 (2.93 to 17.0), 14.8 (5.50 to 39.6), and 15.2 (3.16 to 73.3), with CHA2DS2-VASc Scores of 0 to 1, 2, 3, 4, and ≥5, respectively. A receiver-operating characteristic model had a C-statistic of 0.65 for ischemic stroke, 0.61 for thrombotic stroke, and 0.71 for embolic stroke. In conclusion, in community-dwelling individuals without AF, the CHA2DS2-VASc Score can assess ischemic stroke risk and has good discriminatory capacity for embolic stroke.
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female sex is a risk modifier rather than a risk factor for stroke in atrial fibrillation should we use a cha2ds2 va Score rather than cha2ds2 vasc
Circulation, 2018Co-Authors: Peter Bronnum Nielsen, Gregory Y H Lip, Torben Larsen, Flemming Skjoth, Thure Filskov OvervadAbstract:Background:Stroke risk in atrial fibrillation is assessed by using the CHA2DS2-VASc Score. Sex category (Sc, ie, female sex) confers 1 point on CHA2DS2-VASc. We hypothesized that female sex is a st...
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antithrombotic therapy in atrial fibrillation associated with valvular heart disease executive summary of a joint consensus document fromthe european heart rhythm association ehra and european society of cardiologyworking group on thrombosis endorsed
Thrombosis and Haemostasis, 2017Co-Authors: Gregory Y H Lip, Francisco Marin, Deirdre A Lane, Laurent Fauchier, Jeanphilippe Collet, Raffaele De Caterina, Torben Larsen, Joao Morais, Calambur Narasimhan, Brian OlshanskyAbstract:Management strategies for patients with atrial fibrillation (AF) in association with valvular heart disease (VHD) have been less informed by randomized trials, which have largely focused on ‘non-valvular AF’ patients. Thromboembolic risk also varies according to valve lesion and may also be associated with CHA2DS2-VASc Score risk factor components, rather than only the valve disease being causal. Given the need to provide expert recommendations for professionals participating in the care of patients presenting with AF and associated VHD, a task force was convened by the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group (WG) on Thrombosis, with representation from the ESC WG on Valvular Heart Disease, Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), South African Heart (SA Heart) Association and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE) with the remit to comprehensively review the published evidence, and to produce a consensus document on the management of patients with AF and associated VHD, with up-to-date consensus statements for clinical practice for different forms of VHD, based on the principles of evidence-based medicine. This is an executive summary of a consensus document which proposes that the term ‘valvular AF’ is outdated and given that any definition ultimately relates to the evaluated practical use of oral anticoagulation (OAC) type, we propose a functional EHRA (Evaluated Heartvalves, Rheumatic or Artificial) categorization in relation to the type of OAC use in patients with AF, as follows: EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 1 VHD, which refers to AF patients with ‘VHD needing therapy with a vitamin K antagonist (VKA)’ and EHRA (Evaluated Heartvalves, Rheumatic or Artificial) type 2 VHD, which refers to AF patients with ‘VHD needing therapy with a VKA or a non-VKA oral anticoagulant also taking into consideration CHA2DS2-VASc Score risk factor components.
Peter Bronnum Nielsen - One of the best experts on this subject based on the ideXlab platform.
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female sex is a risk modifier rather than a risk factor for stroke in atrial fibrillation should we use a cha2ds2 va Score rather than cha2ds2 vasc
Circulation, 2018Co-Authors: Peter Bronnum Nielsen, Gregory Y H Lip, Torben Larsen, Flemming Skjoth, Thure Filskov OvervadAbstract:Background:Stroke risk in atrial fibrillation is assessed by using the CHA2DS2-VASc Score. Sex category (Sc, ie, female sex) confers 1 point on CHA2DS2-VASc. We hypothesized that female sex is a st...
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response by nielsen and lip to letter regarding article should patients with atrial fibrillation and 1 stroke risk factor cha2ds2 vasc Score 1 in men 2 in women be anticoagulated yes even 1 stroke risk factor confers a real risk of stroke
Circulation, 2016Co-Authors: Peter Bronnum Nielsen, Gregory Y H LipAbstract:We thank Dr Asinger et al for their comments. On whether or not to provide oral anticoagulant treatment in atrial fibrillation (AF) patients with 1 stroke risk factor, we advocated our viewpoint by using contemporary data from various sources. These data convincingly suggest that AF patients with a CHA2DS2-VASc Score 1 (or 2 in women) benefit from oral anticoagulant (OAC) treatment.1 The point made by Dr Asinger of declining stroke rates in AF populations during the past decades are based on selected populations (eg, Framingham- and Medicare-enrolled patients) that might not generalize into a broader unselected nationwide AF patient population. No trend of …
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should patients with atrial fibrillation and 1 stroke risk factor cha2ds2 vasc Score 1 in men 2 in women be anticoagulated yes even 1 stroke risk factor confers a real risk of stroke
Circulation, 2016Co-Authors: Gregory Y H Lip, Peter Bronnum NielsenAbstract:Although all clinical Scores have modest predictive value for high-risk patients who sustain events, the CHA2DS2-VASc Score is clearly superior in identifying low-risk patients with thromboembolism rates <1%/y who do not need any antithrombotic therapy. Evidence of benefit from oral anticoagulation (OAC) treatment exists for reducing stroke and mortality even in the presence of 1 additional stroke risk factor (ie, CHA2DS2-VASc Score 1 in men or 2 in women). After all, OAC significantly reduces strokes, thromboembolism, and death in patients with atrial fibrillation (AF). Response by Savino and Halperin on p 1503 The risk of stroke is substantially increased in patients with AF, and stroke prevention with OAC is a pivotal part of the management of this common arrhythmia. OAC reduces the risk of stroke by 64% and all-cause mortality by 26% compared with control.1 Despite compelling evidence of benefit, OAC treatment in AF patients is still underused across different parts of the world.2 The risk of stroke in AF is not homogeneous and varies with age and concomitant comorbidities. Comorbidities have been identified from non-OAC arms of the historical trial cohorts and large epidemiological cohorts. To aid clinicians in determining the risk of stroke, various stroke (and bleeding) risk stratification schemes have been proposed, essentially with the aim to answer the binary question, “Will my patient benefit from OAC treatment?” However, the drawback of OAC treatment is the potential to cause serious bleeding (particular intracranial hemorrhage); thus, the prescribing physician (and patient) has to carefully weigh the benefit and harm. Some focus has been directed to various stroke risk stratification schemes, and we are often asked which is best. In 2008, the Stroke Risk in Atrial Fibrillation Working Group3 compared 12 risk stratification schemes and noted not only …
Tachuan Tuan - One of the best experts on this subject based on the ideXlab platform.
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age threshold for the use of non vitamin k antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation insights into the optimal assessment of age and incident comorbidities
European Heart Journal, 2019Co-Authors: Gregory Y H Lip, Tzefan Chao, Yennjiang Lin, Shihlin Chang, Tachuan TuanAbstract:Aims The stroke risk of patients with atrial fibrillation (AF) is not static, since AF patients get older and accumulate more comorbidities after AF is diagnosed. Therefore, the stroke risk of AF patients given certain comorbidities in different age strata should ideally be analysed using an assessment which considers incident comorbidities and the actual age when ischaemic stroke occurred. The goal of the present study is to report the age treatment thresholds for the use of non-vitamin K antagonist oral anticoagulants (NOACs) for AF patients without or with only one comorbidity of the CHA2DS2-VASc Score, based on an ‘ideal method’ of stroke risk assessments. Methods and results The study cohort included 31 039 and 39 020 AF patients who did not have any or had only one risk factor comorbidity of the CHA2DS2-VASc Score except for age and sex. The risks of ischaemic stroke in each age strata for each comorbidities were analysed in three ways, as follows: (i) the conventional way (based on baseline risk factors and age), (ii) dynamic method (patients were censored when new comorbidities occurred), and (iii) an ideal method (patients were censored when new comorbidities occurred and the stroke risk was related to the actual age when stroke happened). The tipping point for the use of NOACs was set at a stroke risk of 0.9%/year. The overall risk of ischaemic stroke using the conventional way was overestimated compared to the dynamic or ideal assessment with the incidence rate ratio of 1.24 for patients with hypertension, 1.20 for heart failure, 1.37 for diabetes mellitus, and 1.38 for vascular diseases; all P-values <0.01. The risk of ischaemic stroke for each age strata was generally higher with the conventional or dynamic methods compared with the ideal assessment. With heart failure, the tipping point (age 35 years) of NOACs was similar, irrespective of methods used for stroke risk assessment. According to the results of ideal assessment, the age thresholds for the use of NOACs for patients with hypertension, diabetes mellitus, and vascular diseases were 50 years, 50 years, and 55 years, respectively. Conclusion Ischaemic stroke risk in AF is heterogeneous, depending on different risk factors with age being as an important driver of stroke risk. Age thresholds for the use of NOACs were different for AF patients having different single risk factors beyond sex despite the same CHA2DS2-VASc Score point (1 for males and 2 for females); that is, 35 years for heart failure, 50 years for hypertension or diabetes, and 55 years for vascular diseases.
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use of oral anticoagulants for stroke prevention in patients with atrial fibrillation who have a history of intracranial hemorrhage
Circulation, 2016Co-Authors: Tzefan Chao, Chiajen Liu, Kangling Wang, Yennjiang Lin, Shihlin Chang, Tachuan Tuan, Tzengji Chen, Jonan Liao, Fapo Chung, Gregory Y H LipAbstract:Background—The risk of further intracranial hemorrhage (ICH) and the benefit of stroke risk reduction with the use of oral anticoagulants for patients who have atrial fibrillation with a history of ICH remain unclear. We aimed to investigate the risks and benefits in patients who have atrial fibrillation with a previous ICH treated with warfarin or antiplatelet drugs in comparison with no antithrombotic therapies. Methods and Results—This study used the National Health Insurance Research Database in Taiwan. Among 307 640 patients who have atrial fibrillation with a CHA2DS2-VASc Score ≧2, 12 917 patients with a history of ICH were identified and were assigned to 1 of 3 groups, that is, no treatment, antiplatelet therapy, and warfarin. Among patients with previous ICH, the rate of ICH and ischemic stroke in untreated patients was 4.2 and 5.8 per 100 person-years, respectively. The annual ICH and ischemic stroke rates in warfarin users were 5.9% and 3.4%, respectively. Among users of antiplatelet agents, the...
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comparisons of chads2 and cha2ds2 vasc Scores for stroke risk stratification in atrial fibrillation which scoring system should be used for asians
Heart Rhythm, 2016Co-Authors: Tzefan Chao, Chiajen Liu, Kangling Wang, Yennjiang Lin, Tachuan Tuan, Sujung Chen, Shihlin ChangAbstract:Background Both U.S. and European guidelines recommend use of the CHA2DS2-VASc rather than CHADS2 Score for stroke risk stratification in atrial fibrillation (AF). However, the CHA2DS2-VASc Score has not been proved to be better than CHADS2 Score for Asians in a large-scale study. Objective The purpose of this study was to compare the accuracies of CHADS2 and CHA2DS2-VASc Scores in predicting ischemic stroke in Chinese patients. Methods This study used the National Health Insurance Research Database in Taiwan. A total of 186,570 AF patients without antithrombotic therapies were selected as the study cohort. The clinical end-point was occurrence of ischemic stroke. Results During follow-up of 3.4 ± 3.7 years, 23,723 patients (12.7%) experienced ischemic stroke. The CHA2DS2-VASc Score performed better than CHADS2 Score in predicting ischemic stroke assessed by c-indexes (0.698 vs 0.659, P Conclusion Patients with a CHADS2 Score of 0 were not necessarily "low risk," and the annual stroke rate can be as high as 4.47% when patients were further stratified by the CHA2DS2-VASc Score. In contrast, patients with a CHA2DS2-VASc Score of 0 had a truly low risk of ischemic stroke, with an annual stroke rate around 1.15%. As with Caucasians, the CHA2DS2-VASc Score should be used for stroke risk stratification in Asians.
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should atrial fibrillation patients with 1 additional risk factor of the cha2ds2 vasc Score beyond sex receive oral anticoagulation
Journal of the American College of Cardiology, 2015Co-Authors: Tzefan Chao, Gregory Y H Lip, Chiajen Liu, Kangling Wang, Yennjiang Lin, Shihlin Chang, Tachuan Tuan, Tzengji Chen, Shihann ChenAbstract:AbstractBackground: Although the CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age ...
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using the cha2ds2 vasc Score for refining stroke risk stratification in low risk asian patients with atrial fibrillation
Journal of the American College of Cardiology, 2014Co-Authors: Tzefan Chao, Gregory Y H Lip, Chiajen Liu, Kangling Wang, Yennjiang Lin, Shihlin Chang, Tachuan Tuan, Tzengji Chen, Shihann ChenAbstract:Abstract Background A new scoring system, the anticoagulation and risk factors in atrial fibrillation (ATRIA) Score, was proposed for risk stratification in patients with atrial fibrillation (AF). Whether the ATRIA scheme can adequately identify patients who are at low risk of ischemic stroke remains unknown. Objectives The goal of the present study was to compare the performance of ATRIA to that of CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74, female) Scores for stroke prediction. Methods This study used the National Health Insurance research database in Taiwan. A total of 186,570 AF patients without antithrombotic therapy were selected as the study cohort. The clinical endpoint was the occurrence of ischemic stroke. Results During the follow-up of 3.4 ± 3.7 years, 23,723 patients (12.7%) experienced ischemic stroke. The CHA2DS2-VASc Score performed better than ATRIA Score in predicting ischemic stroke as assessed by c-indexes (0.698 vs. 0.627, respectively; p Conclusions Patients categorized as low-risk by use of the ATRIA Score were not necessarily low-risk, and the annual stroke rates can be as high as 2.95% at 1-year follow-up and 2.84% at 15-year follow-up. In contrast, patients with a CHA2DS2-VASc Score of 0 had a truly low risk of ischemic stroke, with an annual stroke rate of approximately 1%.
Tzefan Chao - One of the best experts on this subject based on the ideXlab platform.
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age threshold for the use of non vitamin k antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation insights into the optimal assessment of age and incident comorbidities
European Heart Journal, 2019Co-Authors: Gregory Y H Lip, Tzefan Chao, Yennjiang Lin, Shihlin Chang, Tachuan TuanAbstract:Aims The stroke risk of patients with atrial fibrillation (AF) is not static, since AF patients get older and accumulate more comorbidities after AF is diagnosed. Therefore, the stroke risk of AF patients given certain comorbidities in different age strata should ideally be analysed using an assessment which considers incident comorbidities and the actual age when ischaemic stroke occurred. The goal of the present study is to report the age treatment thresholds for the use of non-vitamin K antagonist oral anticoagulants (NOACs) for AF patients without or with only one comorbidity of the CHA2DS2-VASc Score, based on an ‘ideal method’ of stroke risk assessments. Methods and results The study cohort included 31 039 and 39 020 AF patients who did not have any or had only one risk factor comorbidity of the CHA2DS2-VASc Score except for age and sex. The risks of ischaemic stroke in each age strata for each comorbidities were analysed in three ways, as follows: (i) the conventional way (based on baseline risk factors and age), (ii) dynamic method (patients were censored when new comorbidities occurred), and (iii) an ideal method (patients were censored when new comorbidities occurred and the stroke risk was related to the actual age when stroke happened). The tipping point for the use of NOACs was set at a stroke risk of 0.9%/year. The overall risk of ischaemic stroke using the conventional way was overestimated compared to the dynamic or ideal assessment with the incidence rate ratio of 1.24 for patients with hypertension, 1.20 for heart failure, 1.37 for diabetes mellitus, and 1.38 for vascular diseases; all P-values <0.01. The risk of ischaemic stroke for each age strata was generally higher with the conventional or dynamic methods compared with the ideal assessment. With heart failure, the tipping point (age 35 years) of NOACs was similar, irrespective of methods used for stroke risk assessment. According to the results of ideal assessment, the age thresholds for the use of NOACs for patients with hypertension, diabetes mellitus, and vascular diseases were 50 years, 50 years, and 55 years, respectively. Conclusion Ischaemic stroke risk in AF is heterogeneous, depending on different risk factors with age being as an important driver of stroke risk. Age thresholds for the use of NOACs were different for AF patients having different single risk factors beyond sex despite the same CHA2DS2-VASc Score point (1 for males and 2 for females); that is, 35 years for heart failure, 50 years for hypertension or diabetes, and 55 years for vascular diseases.
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use of oral anticoagulants for stroke prevention in patients with atrial fibrillation who have a history of intracranial hemorrhage
Circulation, 2016Co-Authors: Tzefan Chao, Chiajen Liu, Kangling Wang, Yennjiang Lin, Shihlin Chang, Tachuan Tuan, Tzengji Chen, Jonan Liao, Fapo Chung, Gregory Y H LipAbstract:Background—The risk of further intracranial hemorrhage (ICH) and the benefit of stroke risk reduction with the use of oral anticoagulants for patients who have atrial fibrillation with a history of ICH remain unclear. We aimed to investigate the risks and benefits in patients who have atrial fibrillation with a previous ICH treated with warfarin or antiplatelet drugs in comparison with no antithrombotic therapies. Methods and Results—This study used the National Health Insurance Research Database in Taiwan. Among 307 640 patients who have atrial fibrillation with a CHA2DS2-VASc Score ≧2, 12 917 patients with a history of ICH were identified and were assigned to 1 of 3 groups, that is, no treatment, antiplatelet therapy, and warfarin. Among patients with previous ICH, the rate of ICH and ischemic stroke in untreated patients was 4.2 and 5.8 per 100 person-years, respectively. The annual ICH and ischemic stroke rates in warfarin users were 5.9% and 3.4%, respectively. Among users of antiplatelet agents, the...
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comparisons of chads2 and cha2ds2 vasc Scores for stroke risk stratification in atrial fibrillation which scoring system should be used for asians
Heart Rhythm, 2016Co-Authors: Tzefan Chao, Chiajen Liu, Kangling Wang, Yennjiang Lin, Tachuan Tuan, Sujung Chen, Shihlin ChangAbstract:Background Both U.S. and European guidelines recommend use of the CHA2DS2-VASc rather than CHADS2 Score for stroke risk stratification in atrial fibrillation (AF). However, the CHA2DS2-VASc Score has not been proved to be better than CHADS2 Score for Asians in a large-scale study. Objective The purpose of this study was to compare the accuracies of CHADS2 and CHA2DS2-VASc Scores in predicting ischemic stroke in Chinese patients. Methods This study used the National Health Insurance Research Database in Taiwan. A total of 186,570 AF patients without antithrombotic therapies were selected as the study cohort. The clinical end-point was occurrence of ischemic stroke. Results During follow-up of 3.4 ± 3.7 years, 23,723 patients (12.7%) experienced ischemic stroke. The CHA2DS2-VASc Score performed better than CHADS2 Score in predicting ischemic stroke assessed by c-indexes (0.698 vs 0.659, P Conclusion Patients with a CHADS2 Score of 0 were not necessarily "low risk," and the annual stroke rate can be as high as 4.47% when patients were further stratified by the CHA2DS2-VASc Score. In contrast, patients with a CHA2DS2-VASc Score of 0 had a truly low risk of ischemic stroke, with an annual stroke rate around 1.15%. As with Caucasians, the CHA2DS2-VASc Score should be used for stroke risk stratification in Asians.
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should atrial fibrillation patients with 1 additional risk factor of the cha2ds2 vasc Score beyond sex receive oral anticoagulation
Journal of the American College of Cardiology, 2015Co-Authors: Tzefan Chao, Gregory Y H Lip, Chiajen Liu, Kangling Wang, Yennjiang Lin, Shihlin Chang, Tachuan Tuan, Tzengji Chen, Shihann ChenAbstract:AbstractBackground: Although the CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age ...
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using the cha2ds2 vasc Score for refining stroke risk stratification in low risk asian patients with atrial fibrillation
Journal of the American College of Cardiology, 2014Co-Authors: Tzefan Chao, Gregory Y H Lip, Chiajen Liu, Kangling Wang, Yennjiang Lin, Shihlin Chang, Tachuan Tuan, Tzengji Chen, Shihann ChenAbstract:Abstract Background A new scoring system, the anticoagulation and risk factors in atrial fibrillation (ATRIA) Score, was proposed for risk stratification in patients with atrial fibrillation (AF). Whether the ATRIA scheme can adequately identify patients who are at low risk of ischemic stroke remains unknown. Objectives The goal of the present study was to compare the performance of ATRIA to that of CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74, female) Scores for stroke prediction. Methods This study used the National Health Insurance research database in Taiwan. A total of 186,570 AF patients without antithrombotic therapy were selected as the study cohort. The clinical endpoint was the occurrence of ischemic stroke. Results During the follow-up of 3.4 ± 3.7 years, 23,723 patients (12.7%) experienced ischemic stroke. The CHA2DS2-VASc Score performed better than ATRIA Score in predicting ischemic stroke as assessed by c-indexes (0.698 vs. 0.627, respectively; p Conclusions Patients categorized as low-risk by use of the ATRIA Score were not necessarily low-risk, and the annual stroke rates can be as high as 2.95% at 1-year follow-up and 2.84% at 15-year follow-up. In contrast, patients with a CHA2DS2-VASc Score of 0 had a truly low risk of ischemic stroke, with an annual stroke rate of approximately 1%.
Atsushi Amano - One of the best experts on this subject based on the ideXlab platform.
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left atrial appendage closure reduces the incidence of postoperative cerebrovascular accident in patients undergoing cardiac surgery
Circulation, 2015Co-Authors: Tomoko S Kato, Tai Iwamura, Daisuke Endo, Yasutaka Yokoyama, Atsumi Oishi, Akie Shimada, Taira Yamamoto, Kenji Kuwaki, Hirotaka Inaba, Atsushi AmanoAbstract:BACKGROUND Cerebrovascular accidents (CVA) are a major adverse event following cardiac surgery, for which atrial fibrillation (AF) is considered as a risk factor. We have recently performed left atrial appendage (LAA) surgical closure or amputation (LAAC/A), which is the main source of emboli, during open-heart surgery. METHODS AND RESULTS A prospective observational study of 1,831 consecutive patients (69.2% male, aged 66.8±12.2 years) undergoing cardiac surgery between 2009 and 2013 was performed. The incidence of postoperative CVA within 6 months in patients with and without LAAC/A was compared. We further stratified patients according to their risk of CVA using CHA2DS2-VASc Score; dichotomizing low-risk (Score <2) and high-risk groups (≥2). A total of 369 patients (20.2%) underwent LAAC/A. Although these patients had larger left atrial diameter preoperatively and developed postoperative AF more frequently than those without LAAC/A (45.4 vs. 41.1 mm, 49.3 vs. 39.1%, respectively, both P<0.001), the CVA incidence was not different between the groups (3.5 vs. 3.0%, P=0.612). Multivariate analysis revealed no association between LAAC/A and CVA in patients with CHA2DS2-VASc Score ≥2, whereas in patients with CHA2DS2-VASc Score <2, LAAC/A was the only and independent factor negatively associated with CVA development (odds ratio <10(-6); P=0.021). CONCLUSIONS Additional LAA procedure at the time of cardiac surgery reduces the incidence of early postoperative CVA in patients with low CHA2DS2-VASc Score.
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abstract 13614 left atrial appendage closure significantly reduces the incidence of post operative cerebrovascular accidents in patients undergoing cardiac surgery analysis based on a single center prospective observational study
Circulation, 2014Co-Authors: Tai Iwamura, Tomoko S Kato, Yasutaka Yokoyama, Taira Yamamoto, Kenji Kuwaki, Hirotaka Inaba, Hiroshi Nakamura, Terumasa Morita, Atsushi AmanoAbstract:Background: Post-operative cerebrovascular accidents (CVA) are associated with increased mortality and morbidity in patients undergoing cardiac surgery. Atrial fibrillation (AF) has been considered as a major risk factor of CVA. Since the left atrial appendage (LAA) is the main source of emboli, we have performed simultaneous LAA closure or amputation (LAAC) in all patients with enlarged left atrium except for those contraindicated. In the present study, we investigated the effect of LAAC on preventing post-operative CVA. Methods: The study prospectively enrolled 1856 consecutive patients (69.1% male, mean age 66.8±12.2 year old) undergoing cardiac surgery between January 2009 and October 2013 at our institution, including 805 cases (43.3%) of coronary artery bypass surgery (CABG) and 803 cases (43.3%) of valvular surgery. The incidence of early post-operative CVA in patients with and without LAAC was compared. We further stratified patients according to their risk of CVA using CHA2DS2-VASc Score; dichoto...