Renal dysfunction and the risk of thromboembolic events in patients with atrial fibrillation after catheter ablation—The potential role beyond the CHA2DS2-VASc score

Chao, Tze Fan; Tsao, Hsuan Ming; Kibos, Ambrose; Lin, Yenn Jiang; Wang, Lin; Chang, Shih Lin; Lo, Li Wei; Hu, Yu Feng; Tuan, Ta Chuan; Suenari, Kazuyoshi; Li, Cheng Hung; Hartono, Beny; Chang, Hsuan; Hanafy, Dicky Armein; Lin, Wen Yu; Chen, Shih Ann

doi:10.1016/j.hrthm.2012.06.039

Cited by 40 publications

(22 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of all the studies, 6 included only patients off anticoagulation 5,23,27,[32][33][34] and 6 investigated only patients taking oral anticoagulants (OACs). 17,19,[28][29][30][31] Fourteen studies reported the incidence of a composite outcome (ischemic stroke or systematic embolism) as an outcome of interest and 4 studies only reported the incidence of ischemic stroke.…”

Section: Study Characteristicsmentioning

confidence: 99%

Risk of Thromboembolic Events in Atrial Fibrillation With Chronic Kidney Disease

Zeng

Sun

Tang

et al. 2015

Stroke

View full text Add to dashboard Cite

Background and Purpose-Chronic kidney disease may increase the risk for ischemic stroke or systemic embolism in patients with nonvalular atrial fibrillation (AF). We conducted a meta-analysis to summarize all published studies to investigate the link between chronic kidney disease and risk of thromboembolic events in AF. Methods-We performed a literature search using MEDLINE (source PubMed, 1966 and EMBASE (1980 to July 2014) with no restrictions. Pooled effect estimates were obtained by using random-effects meta-analysis. Results-Eighteen studies involving 538 479 patients and 41 719 incident thromboembolic events were identified. From the pooled analysis, AF patients with estimated glomerular filtration rate <60 mL/min compared with those with estimated glomerular filtration rate ≥60 mL/min experienced a significantly increased risk for developing thromboembolic events (relative risk, 1.62 [95% confidence interval, 1.40-1.87; P<0.001]). The annual rate of thromboembolic events increased by 0.41% (95% confidence interval, 0.17%-0.65%) for a 10 mL/min decrease in renal function. Addition of renal impairment to CHADS 2 slightly improved the stroke risk stratification. Conclusions-Impaired renal function is an independent predictor of stroke or systemic embolism in patients with nonvalvular AF. Consideration of renal function may improve stroke risk stratification in patients with AF. (Stroke.

show abstract

Section: Study Characteristicsmentioning

confidence: 99%

Risk of Thromboembolic Events in Atrial Fibrillation With Chronic Kidney Disease

Zeng

Sun

Tang

et al. 2015

Stroke

View full text Add to dashboard Cite

show abstract

“…7,8,10 Similarly, the association between rhythm outcomes and renal dysfunction has been shown recently. 11,12 However, the association between rhythm outcomes and the new R 2 CHADS 2 score was not described previously.…”

mentioning

confidence: 97%

Comparison of CHADS ₂ , R ₂ CHADS ₂ , and CHA ₂ DS ₂ -VASc Scores for the Prediction of Rhythm Outcomes After Catheter Ablation of Atrial Fibrillation

Kornej

Hindricks

Kosiuk

et al. 2014

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…In a recent study, Chao et al investigated the association between renal dysfunction, defined as an estimated glomerular filtration rate <60 millilitres per minute (ml/min) per 1.73 square metres (m 2 ), and the risk of systemic thromboembolisms in 547 patients receiving AF ablation. 40 They found that among patients with a CHA 2 DS 2 -VASc score of 0 or 1 and with no renal dysfunction, the TE event rate was only 0.3 %. The result suggested that it may be safe to discontinue OACs for these patients after catheter ablation of AF.…”

Section: -52mentioning

confidence: 99%

Stroke in Atrial Fibrillation – Long-term Follow-up of Cardiovascular Events

Chao

Chiang

Chen

2013

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice, accounting for approximately one-third of hospitalisations for cardiac rhythm disturbances.1 Between 1980 and 2000, the age-adjusted incidence of AF significantly increased from 3.04 to 3.68 per 1,000 person-years in the US. 2 The prevalence of AF was lower among African Americans than among Caucasians, 3 and it also seemed to be lower in the Asian population. 4,5 In a nationwide cohort of 702,502 participants in Taiwan, the AF incidence was around 1.5 per 1,000 person-years. 6 Since a considerable number of AF patients was paroxysmal in nature, the incidence and prevalence of AF could be significantly underestimated.Systemic thromboembolism is the most severe complication of AF. It accounts for about 15-20 % of ischaemic strokes.7 AF-related strokes were associated with a poor prognosis as more than 50 % of the survivors remain with a severe deficit, and recurrence may be as high as 12 % per year. 8 The risk of AF-related stroke was higher in Caucasian populations than in Asians populations (see Figure 1). 4,[9][10][11][12][13][14][15] AF could in fact drive a prothrombotic or hypercoagulable state, by virtue of its fulfilment of Virchow's triad for thrombogenesis (blood stasis, endocardial dysfunction/damage, and abnormal haemostasis). The most important point in determining the strategy of stroke prevention for AF is how to estimate the thromboembolic (TE) risk accurately. The CHADS 2 score is the most commonly used scheme in stroke risk stratifications for AF patients, 17 despite the fact that it classifies a large proportion of patients as being at 'intermediate risk', and several important TE risk factors were omitted in the scoring system. 18 Recently, a newly developed scoring system, CHA 2 DS 2 -VASc score, which extends the CHADS 2 scheme by considering additional stroke risk factors (vascular diseases and female gender) was recommended to be used to guide the antithrombotic therapies for AF patients. 19,20 The CHA 2 DS 2 -VASc score is most useful in identifying truly low-risk patients, and no antithrombotic therapy is necessary for patients with a CHA 2 DS 2 -VASc score of 0. [21][22][23] In the study performed by Taillandier et al., which enrolled a total of 616 AF patients with a CHA 2 DS 2 -VASc score of 0, an OAC was prescribed on an individual basis in 273 patients (44 %), antiplatelet therapy alone in 145 patients (24 %), and no antithrombotic therapy in 198 patients (32 %).22 During a follow-up of 876 ± 1,135 days, 38 patients experienced adverse events (10 stroke/thromboembolism, 19 major bleeding, 17 deaths). Prescription of OACs and/or antiplatelet therapy was not associated with an improved prognosis for stroke/thromboembolism (relative risk: 0.99, 95 % confidence interval: 0.25-3.99, p-value: 0.99), nor improved survival or net clinical benefit (combination of stroke/ thromboembolism, bleeding and death). More recently, a nationwide cohort study in Taiwan further demonstrated that AF males with a CHA 2 ...

show abstract

Renal dysfunction and the risk of thromboembolic events in patients with atrial fibrillation after catheter ablation—The potential role beyond the CHA2DS2-VASc score

Cited by 40 publications

References 27 publications

Risk of Thromboembolic Events in Atrial Fibrillation With Chronic Kidney Disease

Risk of Thromboembolic Events in Atrial Fibrillation With Chronic Kidney Disease

Comparison of CHADS ₂ , R ₂ CHADS ₂ , and CHA ₂ DS ₂ -VASc Scores for the Prediction of Rhythm Outcomes After Catheter Ablation of Atrial Fibrillation

Stroke in Atrial Fibrillation – Long-term Follow-up of Cardiovascular Events

Contact Info

Product

Resources

About

Renal dysfunction and the risk of thromboembolic events in patients with atrial fibrillation after catheter ablation—The potential role beyond the CHA2DS2-VASc score

Cited by 40 publications

References 27 publications

Risk of Thromboembolic Events in Atrial Fibrillation With Chronic Kidney Disease

Risk of Thromboembolic Events in Atrial Fibrillation With Chronic Kidney Disease

Comparison of CHADS 2 , R 2 CHADS 2 , and CHA 2 DS 2 -VASc Scores for the Prediction of Rhythm Outcomes After Catheter Ablation of Atrial Fibrillation

Stroke in Atrial Fibrillation – Long-term Follow-up of Cardiovascular Events

Contact Info

Product

Resources

About

Comparison of CHADS ₂ , R ₂ CHADS ₂ , and CHA ₂ DS ₂ -VASc Scores for the Prediction of Rhythm Outcomes After Catheter Ablation of Atrial Fibrillation