Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation
Authors: Linda P.T. Joosten, Sander van Doorn, Frans H. Rutten, Geert-Jan Geersing
Journal: Annals of Internal Medicine (2019)

Letters4 June 2019Stroke Rate Variation and Anticoagulation Benefit in Atrial FibrillationLinda P.T. Joosten, MD, Sander van Doorn, MD, PhD, Frans H. Rutten, MD, PhD, and Geert-Jan Geersing, MD, PhDLinda P.T. Joosten, MDJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (L.P.J., S.V., F.H.R., G.G.)Search for more papers by this author, Sander van Doorn, MD, PhDJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (L.P.J., S.V., F.H.R., G.G.)Search for more papers by this author, Frans H. Rutten, MD, PhDJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (L.P.J., S.V., F.H.R., G.G.)Search for more papers by this author, and Geert-Jan Geersing, MD, PhDJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (L.P.J., S.V., F.H.R., G.G.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0129 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read the recent publication by Shah and colleagues with great interest (1). Using data from 4 population-based studies and a rigorous modeling approach, the authors demonstrated the uncertainty of defining the optimal threshold for the CHA2DS2-VASc score above which anticoagulant treatment for stroke prevention in atrial fibrillation (AF) should be initiated. The optimal CHA2DS2-VASc threshold varied considerably, ranging from 0 points (that is, anticoagulation for all patients with AF) to 3 points, depending on the predicted stroke risk for each score.In our recent meta-analysis of all 19 studies validating the CHA2DS2-VASc rule in patients with ...References1. Shah SJ, Eckman MH, Aspberg S, Go AS, Singer DE. Effect of variation in published stroke rates on the net clinical benefit of anticoagulation for atrial fibrillation. Ann Intern Med. 2018;169:517-27. [PMID: 30264130]. doi:10.7326/M17-2762 LinkGoogle Scholar2. van Doorn S, Debray TPA, Kaasenbrood F, Hoes AW, Rutten FH, Moons KGM, et al. Predictive performance of the CHA2DS2-VASc rule in atrial fibrillation: a systematic review and meta-analysis. J Thromb Haemost. 2017;15:1065-77. [PMID: 28375552] doi:10.1111/jth.13690 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (L.P.J., S.V., F.H.R., G.G.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0129. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation Sachin J. Shah , Mark H. Eckman , Sara Aspberg , Alan S. Go , and Daniel E. Singer Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation Sachin J. Shah and Daniel E. Singer Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation Martin Mayer , Brian S. Alper , and Louis Leff Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation David A. Nardone Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation James A. Reiffel Metrics 4 June 2019Volume 170, Issue 11Page: 816-817KeywordsAnticoagulantsAtrial fibrillationDisclosureForecastingHeart failureHypertensionStroke ePublished: 4 June 2019 Issue Published: 4 June 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...