Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2011;64:649-53 - Vol. 64 Num.08 DOI: 10.1016/j.rec.2011.03.013

Impact of New Criteria for Anticoagulant Treatment in Atrial Fibrillation

Moisés Rodríguez-Mañero a,, Alberto Cordero b, Vicente Bertomeu-González b, José Moreno-Arribas b, Vicente Bertomeu-Martínez b, Pilar Mazón c, Lorenzo Fácila d, Juan Cosín e, Iñaki Lekuona f, Enrique Galve g, José R. González-Juanatey c

a Heart Rhythm Management Centre, University Hospital Brussels-UZ Brussels, Belgium
b Departamento de Cardiología, Hospital Universitario de San Juan, Sant Joan d’Alacant, Alicante, Spain
c Departamento de Cardiología, Hospital Complejo Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
d Departamento de Cardiología, Hospital Provincial de Castellón, Castellón de la Plana, Spain
e Departamento de Cardiología, Hospital Arnau de Vilanova, Lleida, Spain
f Departamento de Cardiología, Hospital de Galdakano, Vizcaya, Spain
g Departamento de Cardiología, Hospital Universitario Vall d’Hebron, Barcelona, Spain

Refers to

The Improved but Unfinished Business of Stroke Risk Stratification in Atrial Fibrillation
Amitava Banerjee, Francisco Marín, Gregory Y.H. Lip
Rev Esp Cardiol. 2011;64:639-41
Full text - PDF

Keywords

Atrial fibrillation. Risk stratification. Antithrombotic drugs.

Abstract

Introduction and objectives

The guidelines for the management of atrial fibrillation (AF) incorporate new risk factors for thromboembolism, trying to de-emphasize the use of the ‘low’, ‘moderate’, and ‘high’ risk categories. The objective of this study was to determine the impact of the new scheme CHA2DS2-VASc and of the new recommendations for oral anticoagulation (OAC) in a contemporary sample of patients with AF seen by primary physicians and cardiologists.

Methods

Multicenter, observational, cross-sectional study on the epidemiology of hypertension and its control, designed by the arterial hypertension department. Each researcher enrolled the first 6 consenting patients who came for examination during a 5-day period.

Results

Of 25 137 individuals recruited, 1544 were diagnosed with AF. The vast majority of the sample had a CHADS2 score ≥2 (77.3%). Individuals with a risk score lower than 2 were categorized according to the CHA2DS2-VASc score: 14.4% were aged 75 years or older (CHA2DS2-VASc=2). Of those younger than 75, 42.3% had a CHA2DS2-VASc=2; 23.7% CHA2DS2-VASc=3, and 1.1% CHA2DS2-VASc=4. This means that the 85.1% of the patients with a CHADS2 score<2 and no contraindications are indicated for OAC.

Conclusions

The new recommendations will result in a significant increase in patients with indications for OAC, at the expense of those previously characterized as low-to-moderate risk. Therefore, patients at risk of thromboembolic events must be identified, although an evaluation of bleeding risk should be part of the patient assessment before starting anticoagulation.

1885-5857/© 2011 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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