The CHA2DS2-VASc Score Predicts Major Bleeding in Non-Valvular Atrial Fibrillation Patients Who Take Oral Anticoagulants

Abstract

Background: Patients with atrial fibrillation (AF) are at a substantial risk of ischemic stroke. The CHA2DS2-VASc score predicts the risk of thromboembolism, but its role in predicting major bleeding in patients taking oral anticoagulants is unclear. Methods: We used the National Health Insurance Research Database (NHIRD) of Taiwan to identify patients with AF from 2010 to 2016. They were divided into four groups according to the oral anticoagulants. The outcomes were ischemic stroke/systemic thromboembolism, and major bleeding. Results: A total of 279,776 patients were identified. Ischemic stroke or systemic embolism events were observed in 1.73%, 3.62%, 4.36%, and 5.02% of the patients in the apixaban, rivaroxaban, dabigatran, and warfarin groups, respectively. Major bleeding was recorded in 1.18%, 2.66%, 3.23%, and 4.70% of the patients in the apixaban, rivaroxaban, dabigatran, and warfarin groups, respectively. The highest rates for both ischemic stroke and bleeding events occurred in the patients with a CHA2DS2-VASc score of five or more. Conclusion: Non-valvular AF patients with high CHA2DS2-VASc scores are susceptible to both systemic thromboembolism and major bleeding. The trend was consistently observed in patients who took non-vitamin K oral anticoagulants (NOACs) or warfarin. NOACs might be potentially more effective in reducing overall events.

Comparison of Safety and Efficacy of Warfarin Versus Rivaroxaban in Northern Chinese Patients With Different CHA2DS2-VASc Score

“…These result indicated that AF patients with score 0-1 might be induced bleeding by warfarin. The result was not consistent with previous ndings [19]. They found that the high rates for bleeding events happened in the patients at score ≥ 5.…”

Clinical risk predictors in atrial fibrillation patients following successful coronary stenting: ENTRUST-AF PCI sub-analysis

“…The CHA 2 DS 2 -VASc score was introduced for risk stratification of systemic and cerebral ischaemic events in AF patients. Furthermore, it was shown that this score is useful to predict the overall bleeding risk in AF cohorts [14]. A retrospective study conducted comparative validation of the 6-month GRACE (Global Registry of Acute Coronary Events) risk score and CHA 2 DS 2 -VASc risk score to predict the risk of post-ACS ischaemic stroke [15].…”

Baseline CHA 2 DS 2 ‐VASc score and prognosis in octogenarians with non‐ST segment elevation acute coronary syndrome

“…CHA 2 DS 2 ‐VASc Score has also been shown to predict major bleeding events in non‐valvular AF patients 30 . In our elderly NSTEACS cohort, patients with score > 4 on admission showed a trend toward higher major bleeding and need for transfusion, though they received less antithrombotic treatments and there were no differences about previous bleeding.…”