Senoo Keitaro, Lane Deirdre A, Lip Gregory Y H
University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Int J Cardiol. 2015 Feb 15;181:247-54. doi: 10.1016/j.ijcard.2014.11.196. Epub 2014 Dec 5.
Current clinical guidelines recommend that risk stratification for ischaemic stroke in patients with nonvalvular AF (NVAF) should be performed using the CHA2DS2-VASc score (Congestive heart failure, Hypertension, Age≥ 75years [double], Diabetes mellitus, previous thromboembolism [double], Vascular disease, Age 65-74years, and female gender) to aid decision making for antithrombotic treatment, with a preference for Non-Vitamin K Oral Anticoagulants (NOACs) in those with CHA2DS2-VASc score ≥1. However, CHA2DS2-VASc score is not recommended in the 2014 Japanese Circulation Society (JCS) guidelines for patients with NVAF.
To assess the impact of the JCS approach to stroke prevention in AF, and model the impact of using a CHA2DS2-VASc based 2-step decision making strategy, we calculated the incidence of ischaemic stroke in NVAF patients without OAC on basis of the CHADS2 and CHA2DS2-VASc scores using published Japanese data, and estimated the preventable number of stroke events.
Using a CHA2DS2-VASc-based approach, the potential annual stroke events based on the estimated total number of NVAF patients in Japan was 889,000, as follows: 4369 for dabigatran 150 mg, 6049 for dabigatran 110mg, 5918 for rivaroxaban (intention-to-treat; ITT), 5302 for apixaban, 5843 for edoxaban 60mg (ITT), and 7598 for edoxaban 30 mg (ITT), respectively. Using a CHADS2 score-based approach, the number of potential stroke events was much greater for each agent.
Our modelling analysis has shown that when considering antithrombotic treatment for Japanese NVAF patients, using a CHA2DS2-VASc-based approach would allow greater opportunities for stroke prevention.
当前临床指南建议，对于非瓣膜性房颤（NVAF）患者，应使用CHA2DS2-VASc评分（充血性心力衰竭、高血压、年龄≥75岁[加倍]、糖尿病、既往血栓栓塞[加倍]、血管疾病、年龄65-74岁以及女性）对缺血性中风进行风险分层，以辅助抗栓治疗决策，对于CHA2DS2-VASc评分≥1的患者，优先选择非维生素K口服抗凝剂（NOACs）。然而，2014年日本循环学会（JCS）指南不建议对NVAF患者使用CHA2DS2-VASc评分。
为评估JCS预防房颤中风方法的影响，并模拟基于CHA2DS2-VASc的两步决策策略的影响，我们根据已发表的日本数据，基于CHADS2和CHA2DS2-VASc评分计算未接受口服抗凝剂（OAC）的NVAF患者缺血性中风的发生率，并估计可预防的中风事件数量。
采用基于CHA2DS2-VASc的方法，根据日本NVAF患者估计总数，每年潜在中风事件如下：达比加群150mg为4369例，达比加群110mg为6049例，利伐沙班（意向性治疗；ITT）为5918例，阿哌沙班为5302例，依度沙班60mg（ITT）为5843例，依度沙班30mg（ITT）为7598例。采用基于CHADS2评分的方法，每种药物的潜在中风事件数量要多得多。
我们的模型分析表明，在考虑对日本NVAF患者进行抗栓治疗时，采用基于CHA2DS2-VASc的方法将有更多预防中风的机会。
