Chan Yi-Hsin, Wu Lung-Sheng, Chang Shang-Hung, Lee Hsin-Fu, Liu Jia-Rou, See Lai-Chu, Yeh Yung-Hsin, Kuo Chi-Tai
The Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
PLoS One. 2016 Mar 17;11(3):e0151485. doi: 10.1371/journal.pone.0151485. eCollection 2016.
It is unclear whether oral anticoagulants are beneficial for atrial fibrillation (AF) patients with low CHA2DS2-VASc score. Age could be important in determining the risk of thromboembolism in low risk AF patients (CHA2DS2-VASc score of 1 for male or 2 for female).
The Taiwan National Health Insurance Research Database (NHIRD) was used and 27,521 AF patients with CHA2DS2-VASc score of 1 (male) or 2 (female) not receiving anticoagulants were acquired as the study cohort, which were classified into three age groups: 20-49, 50-64, and 65-74 years. The clinical endpoint was the occurrence of ischemic thromboembolism within one year of follow up.
During the follow-up of 0.94 ± 0.19 years, 385 (2.19%) male patients experienced ischemic thromboembolism, with annual rate of 2.32%. The annual risk ranged from 1.29%, 2.43% to 2.77% for male patients aged 20-49, 50-64 and 65-74 years respectively. Of the female patients, 218 (2.20%) experienced clinical event with annual rate of 2.32%. The annual risk increased from 1.87%, 2.28% to 2.64% for female patients aged 20-49, 50-64 and 65-74 years respectively. There was no difference in risk between the male patients aged 20-49 years with CHA2DS2-VASc score of 1 and overall male patients with CHA2DS2-VASc score of 0. (P = 0.631) The female patients aged 20-49 years with CHA2DS2-VASc score of 2 was associated with a higher risk of thromboembolic events than overall female patients with CHA2DS2-VASc score of 1 (HR = 1.93; P = 0.008).
Age is important in determining the risk of thromboembolism in AF patients with single risk factor. In male patients <50 years old with CHA2DS2-VASc score of 1, the risk of ischemic thromboembolism was low. Considering the benefits and the risk of bleeding, oral anticoagulation therapy may not be favorable in these patients.
口服抗凝剂对CHA2DS2-VASc评分低的心房颤动（AF）患者是否有益尚不清楚。年龄在确定低风险AF患者（男性CHA2DS2-VASc评分为1，女性为2）的血栓栓塞风险方面可能很重要。
使用台湾国民健康保险研究数据库（NHIRD），选取27521例CHA2DS2-VASc评分为1（男性）或2（女性）且未接受抗凝治疗的AF患者作为研究队列，将其分为三个年龄组：20-49岁、50-64岁和65-74岁。临床终点是随访一年内缺血性血栓栓塞的发生情况。
在0.94±0.19年的随访期间，385例（2.19%）男性患者发生缺血性血栓栓塞，年发生率为2.32%。20-49岁、50-64岁和65-74岁男性患者的年风险分别为1.29%、2.43%和2.77%。在女性患者中，218例（2.20%）发生临床事件，年发生率为2.32%。20-49岁、50-64岁和65-74岁女性患者的年风险分别从1.87%、2.28%升至2.64%。CHA2DS2-VASc评分为1的20-49岁男性患者与CHA2DS2-VASc评分为0的总体男性患者的风险无差异（P=0.631）。CHA2DS2-VASc评分为2的20-49岁女性患者发生血栓栓塞事件的风险高于CHA2DS2-VASc评分为1的总体女性患者（HR=1.93；P=0.008）。
年龄在确定单一风险因素的AF患者的血栓栓塞风险中很重要。CHA2DS2-VASc评分为1的<50岁男性患者发生缺血性血栓栓塞的风险较低。考虑到获益和出血风险，这些患者可能不宜接受口服抗凝治疗。
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