Should Every Patient With Atrial Fibrillation and a CHA2DS2-VASc Score of 1 Be Anticoagulated? A Systematic Review of 37,030 Patients

Cardiology in Review
Jolien NeefsJoris R de Groot

Abstract

Patients with atrial fibrillation (AF) are at risk of thromboembolic events. The CHA2DS2-VASc (congestive heart failure, hypertension, age 65-74, diabetes, female sex and vascular disease, which all count for 1 point, and previous transient ischemic stroke/stroke or age ≥ 75 years, which count for two points) score stratifies this risk and consequently indicates whether anticoagulation is required but leaves room for debate regarding patients with a CHA2DS2-VASc score of 1, irrespective of sex. A score of 1, irrespective of sex, is derived from varying risk factors and may represent different risks. We systematically searched PubMed from inception to July 31, 2017, for studies describing thromboembolic risk per risk factor of the CHA2DS2-VASc score in patients with AF not treated with an anticoagulant. Two independent reviewers selected, appraised, and extracted the data to determine the thromboembolic risk per risk factor. Per study, risk factors were ranked for highest through lowest risk. Five studies were included, comprising 37,030 subjects with a CHA2DS2-VASc score of 1. Numerically, the highest event rates were seen in patients without comorbidities, but aged 65-74 years, while event rates in patients with vascular disea...Continue Reading

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Citations

Sep 9, 2020·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·J R de Groot
Jan 23, 2021·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Soonil KwonGregory Y H Lip

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