Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation
Authors: Sachin J. Shah, Daniel E. Singer
Journal: Annals of Internal Medicine (2019)

Letters4 June 2019Stroke Rate Variation and Anticoagulation Benefit in Atrial FibrillationSachin J. Shah, MD, MPH and Daniel E. Singer, MDSachin J. Shah, MD, MPHUniversity of California, San Francisco, San Francisco, California (S.J.S.)Search for more papers by this author and Daniel E. Singer, MDMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (D.E.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0130 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Estimating a patient's stroke risk without treatment is the foundation of anticoagulation decision making when treating patients with AF; this estimate dictates the absolute risk reduction with anticoagulation. Guidelines recommend using the CHA2DS2-VASc score, assuming the score corresponds to a fixed stroke risk.Previously, we documented wide and unappreciated variation in CHA2DS2-VASc score–specific rates of stroke in frequently cited AF cohort studies (1). In their high-quality meta-analysis, Dr. Joosten and colleagues also found wide variation in off-anticoagulation CHA2DS2-VASc score stroke rates, reaffirming the foundation of our analysis (2). In our study, we demonstrate that the variation in reported ...References1. Quinn GR, Severdija ON, Chang Y, Singer DE. Wide variation in reported rates of stroke across cohorts of patients with atrial fibrillation. Circulation. 2017;135:208-19. [PMID: 27799272] doi:10.1161/CIRCULATIONAHA.116.024057 CrossrefMedlineGoogle 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 Scholar3. Quinn GR, Severdija ON, Chang Y, Dallalzadeh LO, Singer DE. Methodologic differences across studies of patients with atrial fibrillation lead to varying estimates of stroke risk. J Am Heart Assoc. 2018;7. [PMID: 29886417] doi:10.1161/JAHA.117.007537 CrossrefMedlineGoogle Scholar4. Go AS, Reynolds K, Yang J, Gupta N, Lenane J, Sung SH, et al. Association of burden of atrial fibrillation with risk of ischemic stroke in adults with paroxysmal atrial fibrillation: the KP-RHYTHM study. JAMA Cardiol. 2018;3:601-8. [PMID: 29799942] doi:10.1001/jamacardio.2018.1176 CrossrefMedlineGoogle Scholar5. Friberg L, Skeppholm M, Terént A. Benefit of anticoagulation unlikely in patients with atrial fibrillation and a CHA2DS2-VASc score of 1. J Am Coll Cardiol. 2015;65:225-32. [PMID: 25614418] doi:10.1016/j.jacc.2014.10.052 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of California, San Francisco, San Francisco, California (S.J.S.)Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (D.E.S.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2762. 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 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 Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation Linda P.T. Joosten , Sander van Doorn , Frans H. Rutten , and Geert-Jan Geersing Metrics 4 June 2019Volume 170, Issue 11Page: 818-819KeywordsAnticoagulant therapyAnticoagulantsAtrial fibrillationCohort studiesDecision makingDisclosureHemorrhagic strokeRisk managementStroke ePublished: 4 June 2019 Issue Published: 4 June 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...