The Impact of Anticoagulation in Patients with Moderate Risk CHA2DS2-VASc

Purpose: Current guidelines recommend the use of anticoagulation for atrial fibrillation (AF) patients with ≥2 non-gender risk factors according to the CHA2DS2-VASc stroke risk score. However, for patients with moderate risk, i.e. 1 non-gender CHA2DS2-VASc score, the use of anticoagulation is left to the discretion of physicians.

Material and Methods: Data on patients aged 18-75 years diagnosed with atrial fibrillation between January 2010 and December 2019 and with ≥3 years of follow-up was pulled from the Research Action for Health Network database (REACHnet). Patients with a history of stroke prior to AF diagnosis were excluded. The primary outcome was the incidence of strokes or transient ischemic attacks.

Results: 1269 patients were included, 31.8% of whom were females. 148 patients (11.7%) were prescribed anticoagulants. 228 (18%) patients achieved the primary outcome. The use of anticoagulation did not significantly affect the risk of stroke (p = 0.57). In addition, among patients administered anticoagulation, there was no significant difference between direct oral anticoagulants and warfarin (p = 1.0).

Conclusions: In patients with moderate-risk CHADS-VASc, the prescription of anticoagulant medications does not affect the risk of strokes or TIAs.