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)
Abstract Background The balance of stroke risk reduction and potential bleeding risk associated with antithrombotic treatment (ATT) remains unclear in atrial fibrillation (AF) at non‐gender CHA2DS2‐VASc scores 0–1. A net clinical benefit (NCB) analysis of ATT may guide stroke prevention strategies i...
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| Format: | Article |
| Language: | English |
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Wiley
2023-06-01
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| Series: | Journal of Arrhythmia |
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| Online Access: | https://doi.org/10.1002/joa3.12840 |
| _version_ | 1827926359830167552 |
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| author | Moonki Jung Kyeongmin Byeon Ki‐Woon Kang Wang‐Soo Lee Sang Wook Kim Yae Min Park You Mi Hwang Sung Ho Lee Eun‐Sun Jin Seung‐Young Roh Jin Seok Kim Jinhee Ahn So‐Ryoung Lee Eue‐Keun Choi Min‐Soo Ahn Eun Mi Lee Hwan‐Cheol Park Ki Hong Lee Min Kim Joon Hyouk Choi Jum Suk Ko Jin Bae Kim Changsoo Kim Gregory Y. H. Lip Seung Yong Shin the Clinical Survey on Stroke Prevention in patients with Atrial Fibrillation (CS‐SPAF) Investigators |
| author_facet | Moonki Jung Kyeongmin Byeon Ki‐Woon Kang Wang‐Soo Lee Sang Wook Kim Yae Min Park You Mi Hwang Sung Ho Lee Eun‐Sun Jin Seung‐Young Roh Jin Seok Kim Jinhee Ahn So‐Ryoung Lee Eue‐Keun Choi Min‐Soo Ahn Eun Mi Lee Hwan‐Cheol Park Ki Hong Lee Min Kim Joon Hyouk Choi Jum Suk Ko Jin Bae Kim Changsoo Kim Gregory Y. H. Lip Seung Yong Shin the Clinical Survey on Stroke Prevention in patients with Atrial Fibrillation (CS‐SPAF) Investigators |
| author_sort | Moonki Jung |
| collection | DOAJ |
| description | Abstract Background The balance of stroke risk reduction and potential bleeding risk associated with antithrombotic treatment (ATT) remains unclear in atrial fibrillation (AF) at non‐gender CHA2DS2‐VASc scores 0–1. A net clinical benefit (NCB) analysis of ATT may guide stroke prevention strategies in AF with non‐gender CHA2DS2‐VASc scores 0–1. Methods 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 CHA2DS2‐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. Results 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). Conclusions In the Korean AF cohort at non‐gender CHA2DS2‐VASc scores 0–1, NOAC showed significant NCB advantages over VKA or SAPT with ABCD score ≥1. |
| first_indexed | 2024-03-13T05:38:03Z |
| format | Article |
| id | doaj.art-e4e63b16fc994441982a97b47aa09b2e |
| institution | Directory Open Access Journal |
| issn | 1880-4276 1883-2148 |
| language | English |
| last_indexed | 2024-03-13T05:38:03Z |
| publishDate | 2023-06-01 |
| publisher | Wiley |
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| series | Journal of Arrhythmia |
| spelling | doaj.art-e4e63b16fc994441982a97b47aa09b2e2023-06-14T05:25:21ZengWileyJournal of Arrhythmia1880-42761883-21482023-06-0139337638710.1002/joa3.12840Net 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)Moonki Jung0Kyeongmin Byeon1Ki‐Woon Kang2Wang‐Soo Lee3Sang Wook Kim4Yae Min Park5You Mi Hwang6Sung Ho Lee7Eun‐Sun Jin8Seung‐Young Roh9Jin Seok Kim10Jinhee Ahn11So‐Ryoung Lee12Eue‐Keun Choi13Min‐Soo Ahn14Eun Mi Lee15Hwan‐Cheol Park16Ki Hong Lee17Min Kim18Joon Hyouk Choi19Jum Suk Ko20Jin Bae Kim21Changsoo Kim22Gregory Y. H. Lip23Seung Yong Shin24the Clinical Survey on Stroke Prevention in patients with Atrial Fibrillation (CS‐SPAF) InvestigatorsDepartment of Cardiology Heart and Brain Hospital, Chung‐Ang University Gwangmyeong Hospital, Chung‐Ang University College of Medicine Gwangmyeong‐si Republic of KoreaDepartment of Cardiology Heart and Brain Hospital, Chung‐Ang University Gwangmyeong Hospital, Chung‐Ang University College of Medicine Gwangmyeong‐si Republic of KoreaCardiovascular & Arrhythmia Center Chung‐Ang University Hospital, Chung‐Ang University Seoul Republic of KoreaCardiovascular & Arrhythmia Center Chung‐Ang University Hospital, Chung‐Ang University Seoul Republic of KoreaCardiovascular & Arrhythmia Center Chung‐Ang University Hospital, Chung‐Ang University Seoul Republic of KoreaDivision of Cardiology, Department of Internal Medicine Gachon University Gil Medical Center Incheon Republic of KoreaDivision of Cardiology, Department of Internal Medicine St. Vincent's Hospital, College of Medicine, The Catholic University of Korea Suwon Republic of KoreaDivision of Cardiology, Department of Internal Medicine Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Seoul Republic of KoreaCardiovascular Center Kyung Hee University Hospital at Gangdong Seoul Republic of KoreaDivision of Cardiology, Department of Internal Medicine Korea University College of Medicine and Korea University Medical Center Seoul Republic of KoreaDivision of Cardiology, Department of Internal Medicine Korea University College of Medicine and Korea University Medical Center Seoul Republic of KoreaDivision of Cardiology, Department of Internal Medicine Pusan National University Hospital Busan Republic of KoreaDepartment of Internal Medicine Seoul National University Hospital Seoul Republic of KoreaDepartment of Internal Medicine Seoul National University Hospital Seoul Republic of KoreaDivision of Cardiology, Department of Internal Medicine Wonju Severance Christian Hospital, Yonsei University, Wonju College of Medicine Wonju Republic of KoreaDivision of Cardiology, Department of Internal Medicine Wonkwang University Sanbon Hospital Gunpo Republic of KoreaDepartment of Cardiology Hanyang University Guri Hospital Guri City Republic of KoreaDivision of Cardiology, Department of Internal Medicine Chonnam National University Medical School Gwangju Republic of KoreaDepartment of Internal Medicine Chungbuk National University Hospital, Chungbuk National University College of Medicine Cheongju Republic of KoreaDivision of Cardiology, Department of Internal Medicine School of Medicine, Jeju National University, Jeju National University Hospital Jeju Republic of KoreaDepartment of Cardiovascular Medicine, Regional Cardiocerebrovascular Center Wonkwang University Hospital Iksan Republic of KoreaDivision of Cardiology, Department of Internal Medicine Kyung Hee University Hospital, School of Medicine, Kyung Hee University Seoul Republic of KoreaDepartment of Preventive Medicine Yonsei University College of Medicine Seoul Republic of KoreaLiverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UKCardiovascular & Arrhythmia Center Chung‐Ang University Hospital, Chung‐Ang University Seoul Republic of KoreaAbstract Background The balance of stroke risk reduction and potential bleeding risk associated with antithrombotic treatment (ATT) remains unclear in atrial fibrillation (AF) at non‐gender CHA2DS2‐VASc scores 0–1. A net clinical benefit (NCB) analysis of ATT may guide stroke prevention strategies in AF with non‐gender CHA2DS2‐VASc scores 0–1. Methods 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 CHA2DS2‐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. Results 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). Conclusions In the Korean AF cohort at non‐gender CHA2DS2‐VASc scores 0–1, NOAC showed significant NCB advantages over VKA or SAPT with ABCD score ≥1.https://doi.org/10.1002/joa3.12840ABCD scoreantithrombotic treatmentatrial fibrillationnet clinical benefitnon‐vitamin K antagonist oral anticoagulant |
| spellingShingle | Moonki Jung Kyeongmin Byeon Ki‐Woon Kang Wang‐Soo Lee Sang Wook Kim Yae Min Park You Mi Hwang Sung Ho Lee Eun‐Sun Jin Seung‐Young Roh Jin Seok Kim Jinhee Ahn So‐Ryoung Lee Eue‐Keun Choi Min‐Soo Ahn Eun Mi Lee Hwan‐Cheol Park Ki Hong Lee Min Kim Joon Hyouk Choi Jum Suk Ko Jin Bae Kim Changsoo Kim Gregory Y. H. Lip Seung Yong Shin the Clinical Survey on Stroke Prevention in patients with Atrial Fibrillation (CS‐SPAF) Investigators 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 ABCD score antithrombotic treatment atrial fibrillation net clinical benefit non‐vitamin K antagonist oral anticoagulant |
| title | 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) |
| title_full | 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) |
| title_fullStr | 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) |
| title_full_unstemmed | 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) |
| title_short | 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) |
| title_sort | 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 |
| topic | ABCD score antithrombotic treatment atrial fibrillation net clinical benefit non‐vitamin K antagonist oral anticoagulant |
| url | https://doi.org/10.1002/joa3.12840 |
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