CHA2DS2-VASc Score, Warfarin Use, and Risk for Thromboembolic Events Among HIV-Infected Persons With Atrial Fibrillation.
CHA2DS2-VASc Score, Warfarin Use, and Risk for Thromboembolic Events Among HIV-Infected Persons With Atrial Fibrillation.
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CHA2DS2-VASc 评分、华法林使用以及患有心房颤动的 HIV 感染者中血栓栓塞事件的风险。
DOI：
10.1097/qai.0000000000001470
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Shlipak,MichaelG
中科院分区：
文献类型：
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作者：
Chau,KatherineHsin-Yu;Scherzer,Rebecca;Grunfeld,Carl;Hsue,PriscillaYing;Shlipak,MichaelG
Background:The prevalence of atrial fibrillation in the HIV-infected population is growing, but the ability of the CHA 2 DS 2-VASc score to predict thromboembolic (TE) risk is unknown in this population.Setting:Within the Veterans Affairs HIV Clinical Case Registry, 914 patients had an atrial fibrillation diagnosis between 1997 and 2011 and no previous TE events.Methods:We compared TE incidence by CHA 2 DS 2-VASc scores and stratified by warfarin use. Using Cox proportional hazards regression with adjustment for competing risks, we modeled associations of CHA 2 DS 2-VASc scores and warfarin use with TE risk.Results:At baseline, the distribution of CHA 2 DS 2-VASc scores was 0 (n= 208), 1 (n= 285), and 2+(n= 421); 34 patients developed 38 TE events during a median of 3.8 years follow-up. Event rates by CHA 2 DS 2-VASc scores of 0, 1, and 2+ were 5.4, 9.3, and 8.1 per 1000 person years, respectively; multivariate-adjusted hazards ratios (HRs) were 1.70 (95% confidence interval: 0.65 to 4.45) for CHA 2 DS 2-VASc score 1 (P= 0.28) and HR= 1.34 (0.51, 3.48) for score 2+ versus 0 (P= 0.55). Baseline warfarin use was associated with increased TE risk, although not statistically significant [HR 2.06 (0.86, 4.93), P= 0.11] with similar results when modeled as time-updated use and duration of use.Conclusion:In this national registry of HIV-infected veterans with atrial fibrillation, CHA 2 DS 2-VASc scores were only weakly associated with TE risk. Furthermore, warfarin did not seem to be effective at preventing TE events. These results should raise concerns about the optimal strategy for TE prevention among HIV-infected persons with atrial fibrillation.
