Benefit of anticoagulation for AF varies across patient populations

Researchers analyzed cohorts from four relevant studies in order to assess the clinical benefit of initiating oral anticoagulation in patients with atrial fibrillation.

Researchers analyzed cohorts from four relevant studies in order to assess the clinical benefit of initiating oral anticoagulation in patients with atrial fibrillation. The studies involved 33,434 community-dwelling adults with incident atrial fibrillation, 27,179 of whom had a CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, stroke, and vascular disease) score of 2 or higher. That is the threshold at which anticoagulation is recommended for this patient population. Under this guideline, however, the benefits of warfarin varied significantly, in terms both quality-adjusted life-years and optimal score threshold for anticoagulation. "Our findings ... indicate that the current guidelines based on CHA2DS2-VASc score may need to be revised in favor of more accurate, individualized assessments of risk for both ischemic stroke and major bleeding," the researchers reported in the Annals of Internal Medicine. An accompanying editorial by Jennifer M. Wright, MD, and Craig T. January, MD, PhD, both of the University of Wisconsin School of Medicine and Public Health Madison, interpreted the findings as a red flag. The research, they wrote, "demonstrates one of the ways in which treatment of patients with [atrial fibrillation] cannot be assumed to be equal across different populations and shows that the CHA2DS2-VASc score threshold for anticoagulation may be not a 'one-size fits-all' approach but rather a starting point for a more tailored assessment."