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)


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 et al (show 15 more authors) (2023) 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). JOURNAL OF ARRHYTHMIA, 39 (3). pp. 376-387.

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Abstract

<h4>Background</h4>The balance of stroke risk reduction and potential bleeding risk associated with antithrombotic treatment (ATT) remains unclear in atrial fibrillation (AF) at non-gender CHA<sub>2</sub>DS<sub>2</sub>-VASc scores 0-1. A net clinical benefit (NCB) analysis of ATT may guide stroke prevention strategies in AF with non-gender CHA<sub>2</sub>DS<sub>2</sub>-VASc scores 0-1.<h4>Methods</h4>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 CHA<sub>2</sub>DS<sub>2</sub>-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.<h4>Results</h4>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).<h4>Conclusions</h4>In the Korean AF cohort at non-gender CHA<sub>2</sub>DS<sub>2</sub>-VASc scores 0-1, NOAC showed significant NCB advantages over VKA or SAPT with ABCD score ≥1.

Item Type: Article
Uncontrolled Keywords: ABCD score, antithrombotic treatment, atrial fibrillation, net clinical benefit, non-vitamin K antagonist oral anticoagulant
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User: Symplectic Admin
Date Deposited: 18 May 2023 13:59
Last Modified: 29 Jun 2023 06:20
DOI: 10.1002/joa3.12840
Open Access URL: https://doi.org/10.1002/joa3.12840
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3170505
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