Oral anticoagulation in nonvalvular atrial fibrillation in clinical practice: impact of CHADS(2) score on outcome.
OBJECTIVE
CHADS(2) score predicts embolic risk in patients with nonvalvular atrial fibrillation (NVAF), but also bleeding risk in patients receiving oral anticoagulation (OAC). Our objective is to analyze the effectiveness and safety of OAC in patients with NVAF in daily clinical practice, according to embolic risk evaluated by means of CHADS(2) score.


METHODS
All consecutive outpatients with permanent NVAF seen at 2 cardiology clinics were prospectively followed for embolic events (transient ischemic attack, ischemic stroke, peripheral embolism) and severe bleedings. OAC was prescribed according to the recommendations of scientific associations. CHADS(2) score was obtained for each patient.


RESULTS
From February 1, 2000 to July 31, 2003, 796 outpatients fulfilled the inclusion criteria. OAC was prescribed to 564 (71%) patients. After 2.4 +/- 1.9 years of follow-up, the embolic event rates (per 100 patient-years) for each stratum of the CHADS(2 )score for patients with/without OAC were: 1/4.1, p = 0.23 (CHADS(2) = 0); 0.6/7.1, p = 0.0018 (CHADS(2) = 1); 0.5/5.1, p = 0.0014 (CHADS(2) = 2); 2.4/12.5, p = 0.0017 (CHADS(2) = 3) and 2.9/20, p = 0.013 (CHADS(2) >or=4). The severe bleeding rates for the same CHADS(2) score strata were 3/0.8, 0.8/0.7, 1.3/0.7, 0.4/0, and 2.9/5 in patients with/without OAC (n.s.).


CONCLUSIONS
OAC is effective and safe in daily clinical practice in patients with NVAF and CHADS(2) score >or=1.
Ruiz Ortiz
Martín
M
Cardiology Department, Hospital Reina Sofía, Cordoba, Spain.
Romo
Elías
E
Mesa
Dolores
D
Delgado
Mónica
M
Anguita
Manuel
M
Castillo
Juan C
JC
Arizón
José M
JM
Suárez de Lezo
José
J
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000401:mortality; D004617:Embolism / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006305:Health Status Indicators; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D015996:Survival Rate
D000925:Anticoagulants