Both authors equally contributed to this work.
The Effect and Safety of the Antithrombotic Therapies in Patients with Atrial Fibrillation and CHADS2 Score 1
Article first published online: 15 DEC 2009
© 2009 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 21, Issue 5, pages 501–507, May 2010
How to Cite
LEE, B. H., PARK, J. S., PARK, J. H., PARK, J. S., KWAK, J. J., HWANG, E. S., KIM, S. K., CHOI, D. H., KIM, Y.-H. and PAK, H.-N. (2010), The Effect and Safety of the Antithrombotic Therapies in Patients with Atrial Fibrillation and CHADS2 Score 1. Journal of Cardiovascular Electrophysiology, 21: 501–507. doi: 10.1111/j.1540-8167.2009.01661.x
This work was supported by a grant of the Korea Health 21 R&D Project (A085136), Ministry of Health & Welfare, Republic of Korea, and Korean Society of Circulation Industry-University Cooperation.
- Issue published online: 15 APR 2010
- Article first published online: 15 DEC 2009
- Manuscript received 13 August 2009; Revised manuscript received 28 September 2009; Accepted for publication 12 October 2009.
- atrial fibrillation;
- antithrombotic therapy;
Anticoagulation in CHADS2 Score 1. Background: The revised ACC/AHA/ESC 2006 guideline recommends either aspirin or warfarin for the prevention of ischemic stroke in patients with atrial fibrillation (AF) in CHADS2 score 1. We hypothesized that warfarin is superior to aspirin therapy for the prevention of stroke without increasing bleeding complication in AF patients with CHADS2 score 1.
Methods and Results: Among 1,502 patients (mean 62.4 ± 13.8 years old, male 65.4%) who were treated for nonvalvular AF without previous stroke, the number of patients with CHADS2 score 1 was 422 (62.9 ± 10.7 years old, male 290 [68.7%]) and their antithrombotic therapies were as follows: warfarin (n = 143), aspirin (n = 124), other antiplatelet (n = 45), and no antithrombosis (none: n = 110). We reviewed the incidences of ischemic stroke, mortality, and bleeding complications during the follow-up period. Results were: (1) during 22.3 ± 17.8 months of follow-up, the incidence of ischemic stroke was significantly lower in warfarin (6 patients, 4.2%, mean international normalized ratio [INR] 2.0 ± 0.5 IU) than in aspirin (16 patients, 12.9%, P = 0.008) than none (23 patients, 20.9%, P < 0.001) without differences in all-cause mortality. (2) The incidence of major bleeding (decrease in hemoglobin ≥2 g/dL, requiring hospitalization or red blood cell transfusion ≥2 pints) was not different between warfarin (2.1%) and aspirin (0.8%, P = NS), but minor bleeding was more common in warfarin (10.5%) than in aspirin (2.4%, P = 0.007).
Conclusion: In AF patients with CHADS2 score 1, warfarin was better to prevent ischemic stroke than aspirin without increasing the incidence of major bleeding complications. However, the incidence of minor bleeding was higher in the warfarin group than the aspirin group. (J Cardiovasc Electrophysiol, Vol. 21, pp. 501-507, May 2010)