ABSTRACT
BACKGROUND: The risk of thromboembolic (TE) complications in atrial fibrillation (AF) patients is not homogeneous. Risk schemes can help target anticoagulant therapy for patients at highest risk of TE complications. OBJECTIVES: To test the predictive ability of 4 risk schemes: The Framingham, the 8th ACCP, the ACC/AHA/ESC 2006, and the CHA2DS2-VASc. METHODS: 186 patients with non-valvular AF and off anticoagulant therapy were included. All subjects who experienced a stroke, transient ischemic attack, or peripheral embolism were identified. Each schema was divided into low, intermediate, and high-risk categories. Discrimination was assessed via the c-statistic. RESULTS: We identified 10 TE events that occurred during 668 person-years off anticoagulation therapy. All risk schemes had fair discriminating ability (c-statistic ranged from 0.59 [for CHA2DS2-VASc] to 0.73 [for Framingham]). The proportion of patients assigned to individual risk categories varied widely across schemes. CHA2DS2-VASc categorized the fewest patients into low and intermediate-risk categories, whereas the Framingham schema assigned the highest patients into low-risk strata. There were no TE events in the low and intermediate-risk categories using CHA2DS2-VASc, whereas the most schemes assigned patients into intermediate-risk category had a event rate ranging from 2.5 (ACC/AHA/ESC and 8th ACCP schemes) to 6% (Framingham). The negative predictive value of TE events was of 100% for the no high-risk patients using CHA2DS2-VASc. CONCLUSIONS: Compared to ACC/AHA/ESC, 8th ACCP, and Framingham, CHA2DS2-VASc risk stratification schema may be better in discriminating between patients at a low and intermediate risk of TE complications.
Subject(s)
Anticoagulants , Atrial Fibrillation/diagnosis , Blood Coagulation , Thromboembolism/diagnosis , Aged , Aged, 80 and over , Atrial Fibrillation/epidemiology , Atrial Fibrillation/physiopathology , Blood Coagulation/physiology , Cohort Studies , Contraindications , Female , Follow-Up Studies , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Risk Assessment/methods , Risk Assessment/standards , Risk Factors , Thromboembolism/epidemiology , Thromboembolism/physiopathologyABSTRACT
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Subject(s)
Humans , Female , Contraception , Pregnancy , Pregnancy, Unwanted , Preventive Medicine , Women's HealthSubject(s)
Contraception , Female , Humans , Pregnancy , Pregnancy, Unwanted , Preventive Medicine , Women's HealthSubject(s)
Community Medicine , Family Practice , Practice Guidelines as Topic , Aged , Female , Humans , Male , Middle Aged , Randomized Controlled Trials as Topic , Spain , World Health OrganizationABSTRACT
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