Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation
Authors: James A. Reiffel
Journal: Annals of Internal Medicine (2019)

Letters4 June 2019Stroke Rate Variation and Anticoagulation Benefit in Atrial FibrillationJames A. Reiffel, MDJames A. Reiffel, MDColumbia University, New York, New York (J.A.R.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0126 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I read with interest the article by Shah and colleagues (1) and the excellent accompanying editorial by Wright and January (2). I commend them for emphasizing that “the CHA2DS2-VASc score threshold for [long-term oral] anticoagulation may be not a ‘one-size-fits-all' approach but rather a starting point for a more tailored assessment” (2), because the thromboembolic risk from AF and net clinical benefit from oral anticoagulation are in part both population- and individual patient–specific and are not dependent only on the comorbidity list encompassed in the CHA2DS2-VASc score. Even more granularity can be added to their comments. First, ...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. Wright JM, January CT. Atrial fibrillation and anticoagulation: one size fits all? Ann Intern Med. 2018;169:575-6. [PMID: 30264144]. doi:10.7326/M18-2355 LinkGoogle Scholar3. Reiffel JA. Optimum risk assessment for stroke in atrial fibrillation: should we hold the status quo or consider magnitude synergism and left atrial appendage anatomy? Arrhythm Electrophysiol Rev. 2017;6:161-6. [PMID: 29326830] doi:10.15420/aer.2017.33.1 CrossrefMedlineGoogle Scholar4. Chen LY, Chung MK, Allen LA, Ezekowitz M, Furie KL, McCabe P, et al; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Stroke Council. Atrial fibrillation burden: moving beyond atrial fibrillation as a binary entity: a Scientific Statement from the American Heart Association. Circulation. 2018;137:e623-44. [PMID: 29661944] doi:10.1161/CIR.0000000000000568 CrossrefMedlineGoogle Scholar5. Reiffel JA. If it were only that simple [Editorial]. Eur Heart J. 2016;37:1603-5. [PMID: 26984857] doi:10.1093/eurheartj/ehw014 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Columbia University, New York, New York (J.A.R.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0126. 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 Linda P.T. Joosten , Sander van Doorn , Frans H. Rutten , and Geert-Jan Geersing Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation David A. Nardone 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 Metrics Cited byComparative effectiveness and safety of non-vitamin-K antagonist oral anticoagulants and warfarin in older adults with atrial fibrillation and diabetes 4 June 2019Volume 170, Issue 11Page: 818KeywordsAtrial fibrillationDisclosureHeartStroke ePublished: 4 June 2019 Issue Published: 4 June 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...