Bleeding and stroke risk in a 'real world' prospective primary prevention cohort of atrial fibrillation patients.
Chest. 2011 Apr 21;
Authors: Poli D, Testa S, Antonucci E, Grifoni E, Paoletti O, Lip GY
AbstractAim All stroke risk stratification schemes categorise a history of previous stroke as a risk factor that is 'truly high risk' patients. Therefore, stratifying stroke risk in AF should perhaps concentrate on primary prevention setting. However, risk factors for stroke also increase bleeding risk. Our aims were to evaluate the agreement among the currently used stroke risk stratification schemes in 'real world' AF patients in the primary prevention setting, their correlation with adverse events recorded during warfarin treatment and the relationship between stroke and bleeding risk. Methods and results We prospectively followed-up 3302 AF patients on warfarin for primary prevention. Stroke risk was assessed using the CHADS(2), AF Investigators, ACCP, ACC/AHA/ESC and NICE schema, and for bleeding risk, the OBRI Index was calculated. Bleeding and thrombotic events occurring during follow-up were recorded. Patients classified into various stroke risk categories widely differed for different schemes, especially for the moderate and high risk categories. The rates of bleeding and thrombotic events during follow-up were 1.24 and 0.76 per 100 patients-yrs, respectively. All stroke stratification schemes closely correlated to bleeding risk. Stroke rate progressively increased from low to moderate and high risk patients. Conclusion. Stroke risk stratification models widely differed when categorising subjects into the moderate and high stroke risk categories. Bleeding and stroke risk were closely correlated and both were low amongst low risk patients, and were similarly high amongst moderate/high risk groups.
PMID: 21511826 [PubMed - as supplied by publisher]