Ischemic Stroke Risk in Patients With Atrial Fibrillation and CHA2DS2-VASc Score of 1: Systematic Review and Meta-Analysis
Ischemic Stroke Risk in Patients With Atrial Fibrillation and CHA2DS2-VASc Score of 1: Systematic Review and Meta-Analysis
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DOI：
10.1161/strokeaha.115.012609
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发表时间：
2016-05-01
期刊：
影响因子：
8.3
通讯作者：
Saposnik, Gustavo
中科院分区：
文献类型：
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作者：
Joundi, Raed A.;Cipriano, Lauren E.;Saposnik, Gustavo
背景和目的CHA(2)DS(2)-VASC评分旨在改善心房颤动患者中缺血性卒中的危险分层，以确定哪些人可以安全地放弃口服抗凝。对于CHA(2)DS(2)-VASc评分为1的口服抗凝治疗指南仍不确定。我们对没有接受口服抗凝治疗的CHA(2)DS(2)-VASc评分为0、1或2的患者发生缺血性卒中的风险进行了系统回顾和荟萃分析。方法从数据库开始到2015年4月15日，我们检索了MEDLINE、Embase、PubMed、Cochrane对照试验中央注册表、Cochrane系统评价数据库和科学网。我们纳入了通过CHA(2)DS(2)-VASc评分对非瓣膜性房颤患者的缺血性卒中风险进行分层的研究。我们使用随机效应荟萃分析估计了缺血性卒中的年总发生率，并将估计的卒中发生率与已公布的启动抗凝剂的净效益阈值进行了比较。结果共检索到1162篇摘要，其中10篇符合研究的所有纳入标准。不同研究之间有很大的异质性。CHA(2)DS(2)-VASc评分为1的年度缺血性中风风险的汇总估计为1.61%(95%可信区间0%-3.23%)，满足使用新型口服抗凝剂的理论阈值(0.9%)，但低于华法林的阈值(1.7%)。CHA(2)DS(2)-VASc评分为0和CHA(2)DS(2)-VASc评分为2的患者发生缺血性卒中的风险分别为0.68%(95%可信区间0.12%~1.23%)和2.49%(95%可信区间1.16%-3.83%)。结论房颤患者发生缺血性卒中风险的Meta分析提示，CHA(2)DS(2)-VASc评分为1的患者可考虑作为一种新型的口服抗凝药物，但由于其高度的异质性，这一决定应根据患者的个体特征做出。
Background and Purpose The CHA(2)DS(2)-VASc score aims to improve risk stratification of ischemic stroke among patients with atrial fibrillation to identify those who can safely forego oral anticoagulation. Oral anticoagulation treatment guidelines remain uncertain for CHA(2)DS(2)-VASc score of 1. We conducted a systematic review and meta-analysis of the risk of ischemic stroke for patients with atrial fibrillation and CHA(2)DS(2)-VASc score of 0, 1, or 2 not treated with oral anticoagulation.Methods We searched MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science from the start of the database up until April 15, 2015. We included studies that stratified the risk of ischemic stroke by CHA(2)DS(2)-VASc score for patients with nonvalvular atrial fibrillation. We estimated the summary annual rate of ischemic stroke using random effects meta-analyses and compared the estimated stroke rates with published net-benefit thresholds for initiating anticoagulants.Results 1162 abstracts were retrieved, of which 10 met all inclusion criteria for the study. There was substantial heterogeneity among studies. The summary estimate for the annual risk of ischemic stroke was 1.61% (95% confidence interval 0%-3.23%) for CHA(2)DS(2)-VASc score of 1, meeting the theoretical threshold for using novel oral anticoagulants (0.9%), but below the threshold for warfarin (1.7%). The summary incident risk of ischemic stroke was 0.68% (95% confidence interval 0.12%-1.23%) for CHA(2)DS(2)-VASc score of 0 and 2.49% (95% confidence interval 1.16%-3.83%) for CHA(2)DS(2)-VASc score of 2.Conclusions Our meta-analysis of ischemic stroke risk in atrial fibrillation patients suggests that those with CHA(2)DS(2)-VASc score of 1 may be considered for a novel oral anticoagulant, but because of high heterogeneity, the decision should be based on individual patient characteristics.