Stroke risk reduction with oral anticoagulation using CHA2DS2-VASc in a Japanese AF population: A modeling analysis.

Abstract:

BACKGROUND:Current clinical guidelines recommend that risk stratification for ischaemic stroke in patients with nonvalvular AF (NVAF) should be performed using the CHA2DS2-VASc score (Congestive heart failure, Hypertension, Age≥ 75years [double], Diabetes mellitus, previous thromboembolism [double], Vascular disease, Age 65-74years, and female gender) to aid decision making for antithrombotic treatment, with a preference for Non-Vitamin K Oral Anticoagulants (NOACs) in those with CHA2DS2-VASc score ≥1. However, CHA2DS2-VASc score is not recommended in the 2014 Japanese Circulation Society (JCS) guidelines for patients with NVAF. METHODS:To assess the impact of the JCS approach to stroke prevention in AF, and model the impact of using a CHA2DS2-VASc based 2-step decision making strategy, we calculated the incidence of ischaemic stroke in NVAF patients without OAC on basis of the CHADS2 and CHA2DS2-VASc scores using published Japanese data, and estimated the preventable number of stroke events. RESULTS:Using a CHA2DS2-VASc-based approach, the potential annual stroke events based on the estimated total number of NVAF patients in Japan was 889,000, as follows: 4369 for dabigatran 150 mg, 6049 for dabigatran 110mg, 5918 for rivaroxaban (intention-to-treat; ITT), 5302 for apixaban, 5843 for edoxaban 60mg (ITT), and 7598 for edoxaban 30 mg (ITT), respectively. Using a CHADS2 score-based approach, the number of potential stroke events was much greater for each agent. CONCLUSION:Our modelling analysis has shown that when considering antithrombotic treatment for Japanese NVAF patients, using a CHA2DS2-VASc-based approach would allow greater opportunities for stroke prevention.

journal_name

Int J Cardiol

authors

Senoo K,Lane DA,Lip GY

doi

10.1016/j.ijcard.2014.11.196

subject

Has Abstract

pub_date

2015-02-15 00:00:00

pages

247-54

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(14)02377-8

journal_volume

181

pub_type

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