Net clinical benefit of oral anticoagulants in Asian patients with atrial fibrillation based on a CHA2DS2-VASc score
Abstract Background This study was conducted to assess the net clinical benefit (NCB) for oral anticoagulant (OAC) in atrial fibrillation (AF) patients according to the CHA2DS2-VASc score. Methods Patients with AF were prospectively recruited in the COOL AF Thailand registry from 2014 to 2017. The i...
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-023-03643-8 |
| _version_ | 1797377192253980672 |
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| author | Komsing Methavigul Ply Chichareon Ahthit Yindeengam Rungroj Krittayaphong |
| author_facet | Komsing Methavigul Ply Chichareon Ahthit Yindeengam Rungroj Krittayaphong |
| author_sort | Komsing Methavigul |
| collection | DOAJ |
| description | Abstract Background This study was conducted to assess the net clinical benefit (NCB) for oral anticoagulant (OAC) in atrial fibrillation (AF) patients according to the CHA2DS2-VASc score. Methods Patients with AF were prospectively recruited in the COOL AF Thailand registry from 2014 to 2017. The incidence rate of thromboembolic (TE) events and major bleeding (MB) was calculated. Cox proportional hazards model was used to compare the TE and MB rate in patients with and without OACs in CHA2DS2-VASc score of 0–1 and ≥ 2, respectively. The survival analysis was performed based on CHA2DS2-VASc score. The NCB of OACs was defined as the TE rate prevented minus the MB rate increased multiplied by a weighting factor. Results A total of 3,402 AF patients were recruited. An average age of patients was 67.38 ± 11.27 years. Compared to non-anticoagulated patients, the Kaplan Meier curve showed anticoagulated patients with CHA2DS2-VASc score of 2 or more had the lower thromboembolic events with statistical significance (p = 0.043) and the higher MB events with statistical significance (p = 0.018). In overall AF patients, there were positive NCB in warfarin patients with CHA2DS2-VASc score of 3 or more while there were positive NCB in DOACs patients regardless of CHA2DS2-VASc score. Females with CHA2DS2-VASc score of 3 or more had a positive NCB regardless of OACs type. Good anticoagulation control (TTR ≥65%) improved an NCB in males with CHA2DS2-VASc score of 3 or more. Conclusions AF patients with CHA2DS2-VASc score of 3 or more regardless warfarin or DOACs had a positive NCB. The NCB of OACs was more positive for DOACs compared to warfarin and for females compared to males. |
| first_indexed | 2024-03-08T19:49:14Z |
| format | Article |
| id | doaj.art-4e534a9f19bc4e05ac4dd3949c6cb6c6 |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-03-08T19:49:14Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-4e534a9f19bc4e05ac4dd3949c6cb6c62023-12-24T12:09:22ZengBMCBMC Cardiovascular Disorders1471-22612023-12-0123111610.1186/s12872-023-03643-8Net clinical benefit of oral anticoagulants in Asian patients with atrial fibrillation based on a CHA2DS2-VASc scoreKomsing Methavigul0Ply Chichareon1Ahthit Yindeengam2Rungroj Krittayaphong3Department of Cardiology, Central Chest Institute of ThailandCardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla UniversityHer Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol UniversityDivision of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol UniversityAbstract Background This study was conducted to assess the net clinical benefit (NCB) for oral anticoagulant (OAC) in atrial fibrillation (AF) patients according to the CHA2DS2-VASc score. Methods Patients with AF were prospectively recruited in the COOL AF Thailand registry from 2014 to 2017. The incidence rate of thromboembolic (TE) events and major bleeding (MB) was calculated. Cox proportional hazards model was used to compare the TE and MB rate in patients with and without OACs in CHA2DS2-VASc score of 0–1 and ≥ 2, respectively. The survival analysis was performed based on CHA2DS2-VASc score. The NCB of OACs was defined as the TE rate prevented minus the MB rate increased multiplied by a weighting factor. Results A total of 3,402 AF patients were recruited. An average age of patients was 67.38 ± 11.27 years. Compared to non-anticoagulated patients, the Kaplan Meier curve showed anticoagulated patients with CHA2DS2-VASc score of 2 or more had the lower thromboembolic events with statistical significance (p = 0.043) and the higher MB events with statistical significance (p = 0.018). In overall AF patients, there were positive NCB in warfarin patients with CHA2DS2-VASc score of 3 or more while there were positive NCB in DOACs patients regardless of CHA2DS2-VASc score. Females with CHA2DS2-VASc score of 3 or more had a positive NCB regardless of OACs type. Good anticoagulation control (TTR ≥65%) improved an NCB in males with CHA2DS2-VASc score of 3 or more. Conclusions AF patients with CHA2DS2-VASc score of 3 or more regardless warfarin or DOACs had a positive NCB. The NCB of OACs was more positive for DOACs compared to warfarin and for females compared to males.https://doi.org/10.1186/s12872-023-03643-8Net clinical benefitAnticoagulantDual antithromboticAtrial fibrillationCHA2DS2-VASc |
| spellingShingle | Komsing Methavigul Ply Chichareon Ahthit Yindeengam Rungroj Krittayaphong Net clinical benefit of oral anticoagulants in Asian patients with atrial fibrillation based on a CHA2DS2-VASc score BMC Cardiovascular Disorders Net clinical benefit Anticoagulant Dual antithrombotic Atrial fibrillation CHA2DS2-VASc |
| title | Net clinical benefit of oral anticoagulants in Asian patients with atrial fibrillation based on a CHA2DS2-VASc score |
| title_full | Net clinical benefit of oral anticoagulants in Asian patients with atrial fibrillation based on a CHA2DS2-VASc score |
| title_fullStr | Net clinical benefit of oral anticoagulants in Asian patients with atrial fibrillation based on a CHA2DS2-VASc score |
| title_full_unstemmed | Net clinical benefit of oral anticoagulants in Asian patients with atrial fibrillation based on a CHA2DS2-VASc score |
| title_short | Net clinical benefit of oral anticoagulants in Asian patients with atrial fibrillation based on a CHA2DS2-VASc score |
| title_sort | net clinical benefit of oral anticoagulants in asian patients with atrial fibrillation based on a cha2ds2 vasc score |
| topic | Net clinical benefit Anticoagulant Dual antithrombotic Atrial fibrillation CHA2DS2-VASc |
| url | https://doi.org/10.1186/s12872-023-03643-8 |
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