Validation of Risk Scoring System Excluding Female Sex From CHA&lt;sub&gt;2&lt;/sub&gt;DS&lt;sub&gt;2&lt;/sub&gt;-VASc in Japanese Patients With Nonvalvular Atrial Fibrillation　– Subanalysis of the J-RHYTHM Registry –

Tomita, Hirofumi; Okumura, Ken; Inoue, Hiroshi; Atarashi, Hirotsugu; Yamashita, Takeshi; Origasa, Hideki; Tsushima, Eiki

doi:10.1253/circj.cj-15-0095

Cited by 47 publications

(38 citation statements)

References 36 publications

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“…1 The study also confirmed there was no significant difference between the CHA2DS2-VASc score and their proposed CHA2DS2-VA score (a modified risk scoring system that excludes female sex as a variable from the CHA2DS2-VASc were independent risk factors for ischemic stroke. In contrast, female sex was not identified as a risk factor for thromboembolism.…”

Section: Article P 1719supporting

confidence: 58%

New Modified CHA2DS2-VA Scoring System for Japanese Patients With Non-Valvular Atrial Fibrillation

Abe

Koretsune

2015

Circ J

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1682ABE H et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp score) in both men and women. They conclude that their CHA2DS2-VA score may be more useful in Japanese NVAF patients than the conventional CHA2DS2-VASc score, particularly in the identification of truly low-risk patients. Previous studies from other countries have produced mixed results. In Sweden, Friberg et al reported that although there was no sex difference observed in stroke incidence for younger patients, women aged ≥75 years were found to have a higher stroke incidence than similarly aged men. 2 In a Canadian study, Avgil Tsadok et al 3 examined the stroke incidence rate in older AF patients with and without warfarin therapy, and found no sex difference in stroke incidence for these patients within 30 days after discharge. However, stroke incidence was found to be significantly higher in women aged ≥75 years, regardless of warfarin therapy. In addition, validation of the CHA2DS2-VASc scoring system was conducted using a Danish study population in which the majority of women were at least 65 years of age. 4 In a French study, Olesen et al calculated the event rates of stroke or thromboembolism for different age categories (<65, 65-74, and ≥75 years); in NVAF patients aged <65 years, the presence of heart failure, previous stroke, or vascular disease were found to be independent risk factors for stroke and thromboembolism. 5 Those authors concluded that stroke risk stratification using the CHADS2 score could be improved by adding the 2 risk factors of being aged 65-74 years and vascular disease.Why is the incidence of stroke and thromboembolism higher in elderly women? Cove et al explored this question in an t is important to identify non-valvular atrial fibrillation (NVAF) patients at risk of thromboembolism, and to appropriately administer antithrombotic therapy to them. On the other hand, it is also important to identify truly lowrisk patients because bleeding complications related to antithrombotic therapy are not uncommon. The CHA2DS2-VASc score has been proposed as a method of evaluating the risk levels of such patients, and this score includes vascular disease, age of 65-74 years, and female sex as risk items. Although a CHA2DS2-VASc score of 0 indicates an extremely low risk for thromboembolism, a woman would be allocated 1 point in this scoring system from the time that she was born. It is therefore apparent that the CHA2DS2-VASc scoring system has limited applications if it does not clarify at what age the risk of thromboembolism begins to increase in women. Article p 1719In this issue of the Journal, Tomita et al conduct an examination of 997 Japanese patients (mean age 68 years, 29% women) with NVAF who did not receive warfarin therapy, and found no significant sex difference in the annual incidence of thromboembolism (1.2% for women, 1.6% for men; odds ratio [OR] 0.72, 95% confidence interval [CI] 0.28-1.62; P=0.44). 1 The study also confirmed there was no significant difference be...

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Section: Article P 1719supporting

confidence: 58%

New Modified CHA2DS2-VA Scoring System for Japanese Patients With Non-Valvular Atrial Fibrillation

Abe

Koretsune

2015

Circ J

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“…Therefore, DAPT was preferred over a single antiplatelet agent, likely because 73% of patients had an ACS as index event, in accordance with other studies. 24, 39 In agreement with our results, both Tomita et al 43 and Okumura et al 44 recently reported that patients with AF and modified CHA2DS2-VASc score=1 (registry did not include peripheral artery disease or aortic plaque) had a truly low risk of thromboembolism (0.86%), even when female sex was excluded (1.0%), suggesting that the use of anticoagulation must be avoided in this subgroup of patients. 43, 44 On the other hand, Abe et al 45 found no significant sex difference in the annual incidence of thromboembolism (1.2% for women, 1.6% for men; odds ratio 0.72, 95% CI 0.28-1.62; P=0.44).…”

Section: Study Limitationssupporting

confidence: 89%

Effects of Triple Therapy in Patients With Non-Valvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention Regarding Thromboembolic Risk Stratification

Sambola

Mutuberría

Blanco

et al. 2016

Circ J

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“…We also recently validated this score in a Japanese cohort, in which NVAF patients with HAS-BLED score ≥3 have been shown to be at high risk of bleeding [4]. In the present study, we assessed significance of each risk factor individually comprising of HAS-BLED scoring system in Japanese NVAF patients receiving warfarin treatment enrolled in the J-RHYTHM Registry.The J-RHYTHM Registry is an observational cohort study that aims to determine optimal anticoagulation levels for preventing thromboembolic and bleeding events in 7937 Japanese AF patients, who were prospectively followed up for 2 years [4][5][6]. Of them, 6065 NVAF patients receiving warfarin treatment were analyzed by focusing on the incidences of major bleeding requiring hospitalization (MB) and intracranial hemorrhage (ICH) (mean age 70 ± 10 years, 4314 males).…”

mentioning

confidence: 99%

Assessment of risk factors for bleeding in Japanese patients with non-valvular atrial fibrillation receiving warfarin treatment: A subanalysis of the J-RHYTHM Registry

Tomita

Okumura

Inoue

et al. 2015

International Journal of Cardiology

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Validation of Risk Scoring System Excluding Female Sex From CHA<sub>2</sub>DS<sub>2</sub>-VASc in Japanese Patients With Nonvalvular Atrial Fibrillation　– Subanalysis of the J-RHYTHM Registry –

Cited by 47 publications

References 36 publications

New Modified CHA<sub>2</sub>DS<sub>2</sub>-VA Scoring System for Japanese Patients With Non-Valvular Atrial Fibrillation

New Modified CHA<sub>2</sub>DS<sub>2</sub>-VA Scoring System for Japanese Patients With Non-Valvular Atrial Fibrillation

Effects of Triple Therapy in Patients With Non-Valvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention Regarding Thromboembolic Risk Stratification

Assessment of risk factors for bleeding in Japanese patients with non-valvular atrial fibrillation receiving warfarin treatment: A subanalysis of the J-RHYTHM Registry

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Validation of Risk Scoring System Excluding Female Sex From CHA<sub>2</sub>DS<sub>2</sub>-VASc in Japanese Patients With Nonvalvular Atrial Fibrillation – Subanalysis of the J-RHYTHM Registry –

Cited by 47 publications

References 36 publications

New Modified CHA<sub>2</sub>DS<sub>2</sub>-VA Scoring System for Japanese Patients With Non-Valvular Atrial Fibrillation

New Modified CHA<sub>2</sub>DS<sub>2</sub>-VA Scoring System for Japanese Patients With Non-Valvular Atrial Fibrillation

Effects of Triple Therapy in Patients With Non-Valvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention Regarding Thromboembolic Risk Stratification

Assessment of risk factors for bleeding in Japanese patients with non-valvular atrial fibrillation receiving warfarin treatment: A subanalysis of the J-RHYTHM Registry

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Validation of Risk Scoring System Excluding Female Sex From CHA<sub>2</sub>DS<sub>2</sub>-VASc in Japanese Patients With Nonvalvular Atrial Fibrillation　– Subanalysis of the J-RHYTHM Registry –