Anticoagulation for atrial fibrillation patients with the CHA2DS2-VASc score =1 (beyond sex)

Abstract

Objective We investigated the risk of ischaemic stroke in patients with 1 another stroke risk factor (i.e. CHA2DS2-VASc score =1 [males] or 2 [females]) and the impact of different component risk factors. Methods Database were collected from two hospitals in the city of Hohhot in china. Among 3148 Nonvalvular AF patients not on antiplatelet or anticoagulant therapy, we evaluated males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2. The clinical endpoint was the occurrence of ischaemic stroke. Results Among 546 AF male patients with a CHA2DS2-VASc score of 1, there were 44 patients (8.06%) who experienced ischaemic stroke during follow-up (3.4 ± 2.1 years) with an annual stroke rate of 2.62%. The risk of ischaemic stroke ranged from 1.86%/year for patients with vascular diseases to 3.33%/year for those age 65–74 years of age. For the female patients with 653 AF, 54 (8.27%) experienced ischaemic stroke during follow-up (3.4 ± 2.1 years) , for an annual stroke rate of 2.76%. The risk of ischaemic stroke increased from 1.96%/year for patients with vascular diseases to 3.38%/year for those 65–74 years of age. Conclutions The risk of each factor is not equal in CHA2DS2-VASc score, with age 65–74 years associated with the highest stroke rate. Oral anticoagulation should be considered for AF patients with 1 another stroke risk factor given their high risk of ischaemic stroke. Article summary: The risk of each factor is not equal in CHA2DS2-VASc score. Atrial fibrillation is a risk factor of ischaemic stroke. Oral anticoagulation should be considered for AF patients with 1 another stroke risk factor given their high risk of ischaemic stroke. It is the retrospective nature of the study. We were not able to clearly confirm the cause of ischaemic stroke because it can be due to AF-related thromboembolism or atherosclerosis and thrombosis of the cerebral artery.