Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation
Authors: Martin Mayer, Brian S. Alper, Louis Leff
Journal: Annals of Internal Medicine (2019)

Letters4 June 2019Stroke Rate Variation and Anticoagulation Benefit in Atrial FibrillationMartin Mayer, DMSc, MS, PA-C, Brian S. Alper, MD, MSPH, and Louis Leff, MDMartin Mayer, DMSc, MS, PA-CEBSCO Health and Vidant Medical Center, Greenville, North Carolina (M.M.)Search for more papers by this author, Brian S. Alper, MD, MSPHEBSCO Health and University of Missouri–Columbia, Columbia, Missouri (B.S.A.)Search for more papers by this author, and Louis Leff, MDUniversity of Pittsburgh Medical Center and EBMcalc, Pittsburgh, Pennsylvania (L.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0125 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Shah and colleagues (1) add to recent literature (2) noting considerable differences in reported off-treatment rates of ischemic stroke in nonvalvular AF by exploring the resulting differences in perceived net benefit of anticoagulant therapy. This raises a fundamental question of how to determine a “best” estimate of off-treatment risk for ischemic stroke for patients with nonvalvular AF.Shah and colleagues compare 4 cohorts in their analysis (the ATRIA, Swedish, Danish, and SPORTIF cohorts) and note strengths and weaknesses of the data from each cohort. Their discussion highlights how selecting a “best” estimate often involves judgment and cannot ...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. 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 Scholar3. Olesen JB, Lip GY, Hansen ML, Hansen PR, Tolstrup JS, Lindhardsen J, et al. Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study. BMJ. 2011;342:d124. [PMID: 21282258] doi:10.1136/bmj.d124 CrossrefMedlineGoogle Scholar4. Singer DE, Chang Y, Borowsky LH, Fang MC, Pomernacki NK, Udaltsova N, et al. A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: the ATRIA study stroke risk score. J Am Heart Assoc. 2013;2:e000250. [PMID: 23782923] doi:10.1161/JAHA.113.000250 CrossrefMedlineGoogle Scholar5. Friberg L, Rosenqvist M, Lip GY. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J. 2012;33:1500-10. [PMID: 22246443] doi:10.1093/eurheartj/ehr488 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: EBSCO Health and Vidant Medical Center, Greenville, North Carolina (M.M.)EBSCO Health and University of Missouri–Columbia, Columbia, Missouri (B.S.A.)University of Pittsburgh Medical Center and EBMcalc, Pittsburgh, Pennsylvania (L.L.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0125. 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 James A. Reiffel 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 Metrics 4 June 2019Volume 170, Issue 11Page: 817-818KeywordsAnticoagulant therapyAtrial fibrillationDisclosureHospitalizationsIschemic strokePulmonary arteriesPulmonary embolismRisk managementStrokeVitamin K ePublished: 4 June 2019 Issue Published: 4 June 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...