The various risk stratification schemes classified variable proportions as low , moderate and high risk , but the CHA(2)DS(2)-VASc score classified the smallest proportion of patients as ' low risk ' .
Anticoagulation with vitamin K antagonists and dabigatran is cost-effective in patients at high risk of stroke , but not in patients without any other stroke risk factor beside AF .
Feasibility of TEE-guided stroke risk assessment in atrial fibrillation—background, aims, design and baseline data of the TIARA pilot study
Background Antithrombotic management in atrial fibrillation ( AF ) is currently based on clinical characteristics , despite evidence of potential fine-tuning with transoesophageal echocardiography ( TEE ) . This open , r and omised , multicentre study addresses the hypothesis that a comprehensive strategy of TEE-based aspirin treatment in AF patients is feasible and safe . Methods Between 2005 and 2009 , ten large hospitals in the Netherl and s enrolled AF patients with a moderate risk of stroke . Patients without thrombogenic TEE characteristics were r and omised to aspirin or vitamin K antagonists ( VKA ) . The primary objective is to show that TEE-based aspirin treatment is safe compared with VKA therapy . The secondary objective tests feasibility of TEE as a tool to detect echocardiographic features of high stroke risk . This report compares r and omised to non-r and omised patients and describes the feasibility of a TEE-based approach . Results In total , 310 patients were included . Sixty-nine patients were not r and omised because of non-visualisation ( n = 6 ) or TEE risk factors ( n = 63 ) . Compared with non-r and omised patients , r and omised patients ( n = 241 ) were younger ( 65 ± 11 vs. 69 ± 9 years , p = 0.004 ) , had less  coronary artery disease ( 9 vs. 20 % , p = 0.018 ) , previous TIA ( 1.7 vs. 7.2 % , p = 0.029 ) , AF during TEE ( 25 vs. 54 % , p < 0.001 ) , mitral incompetence ( 55 vs. 70 % , p = 0.038 ) , VKA use ( 69 vs. 82 % , p = 0.032 ) , had a lower mean CHADS2 score ( 1.2 ± 0.6 vs. 1.6 ± 1.0 , p = 0.004 ) , and left ventricular ejection fraction ( 59 ± 8 vs. 56 ± 8 % , p = 0.016 ) . Conclusions This study shows that a TEE-based approach for fine-tuning stroke risk in AF patients with a moderate risk for stroke is feasible . Follow-up data will address the safety of this TEE-based approach
The various risk stratification schemes classified variable proportions as low , moderate and high risk , but the CHA(2)DS(2)-VASc score classified the smallest proportion of patients as ' low risk ' .
Anticoagulation with vitamin K antagonists and dabigatran is cost-effective in patients at high risk of stroke , but not in patients without any other stroke risk factor beside AF .