Bai Ying, Shantsila Alena, Lip Gregory Y H
a University of Birmingham Institute of Cardiovascular Sciences, City Hospital , Birmingham , United Kingdom.
b Cardiovascular Center, Beijing Tongren Hospital, Capital University , Beijing , China.
Expert Rev Cardiovasc Ther. 2017 Feb;15(2):145-150. doi: 10.1080/14779072.2017.1281742. Epub 2017 Jan 20.
The use of anticoagulation for stroke prevention in patients with atrial fibrillation (AF) and CHADS-VASc score of 1 has been debated, partially due to limited data on ischemic stroke risk and specific clinical trials in these patients. East Asian patients have a different stroke risk profile compared to non-East Asians. We performed a systematic review and meta-analysis of ischemic stroke risk in AF patients with a CHADS-VASc score of 1 in East Asian countries.
A comprehensive literature search for studies evaluating ischemic stroke risk related with AF with CHADS-VASc score of 1 was conducted by two reviewers. We used a fixed-effect model first, then a random-effect model if heterogeneity was assessed with I.
After pooling 6 studies, the annual rate of ischemic stroke in East Asian patients with AF and a CHADS-VASc score of 1 was 1.66% (95% CI: 0.71%-2.61%, I2 = 98.4%). There was a wide range in reported pooled rates between countries, from 0.59% to 3.13%. Significant difference existed not only in the community-based studies (Chinese: 2.10% vs. Japanese: 0.60%), but also from the hospital-based studies (Chinese: 3.55% vs. Japanese: 0.42%). Confining the analysis to those on no antithrombotic treatment had limited effect on the summary estimate (eg. Chinese: 4.28% vs. Japanese: 0.6%). In Chinese studies, ischemic stroke rate was lower in females than males (female: 1.40% vs. male: 1.79%). However, the low event rate in Japanese studies may reflect unrecorded anticoagulation status at follow-up.
Some regional differences between East Asian countries were observed for ischemic stroke risk in patients with a CHADS-VASc score of 1. This may reflect methodological differences in studies and unrecorded anticoagulation use at followup, but further prospective studies are required to ascertain ischemic stroke risks, as well as the differences and reasons for this between East Asians and non-East Asians.
对于心房颤动（AF）且CHADS-VASc评分为1的患者，使用抗凝药物预防卒中一直存在争议，部分原因是关于这些患者缺血性卒中风险的数据有限，且缺乏针对他们的特定临床试验。与非东亚患者相比，东亚患者的卒中风险特征有所不同。我们对东亚国家CHADS-VASc评分为1的AF患者的缺血性卒中风险进行了系统评价和荟萃分析。
两名研究者对评估CHADS-VASc评分为1的AF患者缺血性卒中风险的研究进行了全面的文献检索。我们首先使用固定效应模型，如果用I评估存在异质性，则使用随机效应模型。
汇总6项研究后，东亚CHADS-VASc评分为1的AF患者的年度缺血性卒中发生率为1.66%（95%CI：0.71%-2.61%，I²=98.4%）。各国报告的汇总发生率差异很大，从0.59%到3.13%不等。不仅在基于社区的研究中存在显著差异（中国：2.10% vs. 日本：0.60%），在基于医院的研究中也存在显著差异（中国：3.55% vs. 日本：0.42%）。将分析局限于未进行抗栓治疗的患者对汇总估计的影响有限（例如，中国：4.28% vs. 日本：0.6%）。在中国的研究中，女性的缺血性卒中发生率低于男性（女性：1.40% vs. 男性：1.79%）。然而，日本研究中的低事件发生率可能反映了随访时未记录的抗凝状态。
东亚国家之间，CHADS-VASc评分为1的患者在缺血性卒中风险方面存在一些地区差异。这可能反映了研究方法的差异以及随访时未记录的抗凝药物使用情况，但需要进一步的前瞻性研究来确定缺血性卒中风险，以及东亚人与非东亚人之间的差异和原因。
