Oral anticoagulation in patients with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1: a current opinion of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and European Society of Cardiology Council on Stroke

Patrick Sulzgruber; Sven Wassmann; Anne Grete Semb; Wolfram Doehner; Petr Widimsky; Thomas Gremmel; Juan Carlos Kaski; Gianluigi Savarese; Giuseppe M C Rosano; Claudio Borghi; Keld Kjeldsen; Christian Torp-Pedersen; Thomas Andersen Schmidt; Basil S Lewis; Heinz Drexel; Juan Tamargo; Dan Atar; Stefan Agewall; Alexander Niessner

doi:10.1093/ehjcvp/pvz016

Oral anticoagulation in patients with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1: a current opinion of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and European Society of Cardiology Council on Stroke

Eur Heart J Cardiovasc Pharmacother. 2019 Jul 1;5(3):171-180. doi: 10.1093/ehjcvp/pvz016.

Authors

Patrick Sulzgruber¹, Sven Wassmann^{2

3}, Anne Grete Semb⁴, Wolfram Doehner^{5

6}, Petr Widimsky⁷, Thomas Gremmel^{1

8}, Juan Carlos Kaski⁹, Gianluigi Savarese¹⁰, Giuseppe M C Rosano^{11

12}, Claudio Borghi¹³, Keld Kjeldsen^{14

15}, Christian Torp-Pedersen^{16

17}, Thomas Andersen Schmidt¹⁸, Basil S Lewis^{19

20}, Heinz Drexel^{21

22}, Juan Tamargo²³, Dan Atar²⁴, Stefan Agewall²⁴, Alexander Niessner¹

Affiliations

¹ Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
² Cardiology Pasing, Institutstraße 14, 81241 Munich, Germany.
³ University of the Saarland, Kirrberger Straße 100, 66424 Homburg, Saar, Germany.
⁴ Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Diakonveien 12, 0370 Oslo, Norway.
⁵ Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), Oudenarder Straße 16, 13316 Berlin, Germany.
⁶ BIH Center for Regenerative Therapies (BCRT), Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
⁷ Cardiocenter, Third Faculty of Medicine, Charles University, Opletalova 38, 110 00 Staré Město, Prague, Czech Republic.
⁸ Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700 Wiener Neustadt, Austria.
⁹ Molecular and Clinical Sciences Research Institute, St George's, University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK.
¹⁰ Cardiology Division, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Eugeniavägen 3, 171 76 Solna, Stockholm, Sweden.
¹¹ IRCCS San Raffaele Roma, Via della Pisana, 235, 00163 Roma, Italy.
¹² St George's Hospitals NHS Trust, University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK.
¹³ Atherosclerosis Research Unit, Medical and Surgical Sciences Department, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Zamboni, 33, 40126 Comune di Bologna BO, Italy.
¹⁴ Department of Cardiology, Copenhagen University Hospital (Hvidovre-Amager), Blegdamsvej 9, 2100 Copenhagen, Denmark.
¹⁵ Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Fredrik Bajers Vej 5, 9100 Aalborg, Denmark.
¹⁶ Department of Health Sciences and Technology, Aalborg University, Fredrik Bajers Vej 5, 9100 Aalborg, Denmark.
¹⁷ Department of Cardiology, Aalborg University Hospital, Fredrik Bajers Vej 5, 9100 Aalborg, Denmark.
¹⁸ Emergency Department, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.
¹⁹ Lady Davis Carmel Medical Center, Mikhal St 7, 3436212 Haifa, Israel.
²⁰ Technion-Israel Institute of Technology, Ruth and Bruce Rappaport School of Medicine, Efron St 1, 3436212 Haifa, Israel.
²¹ VIVIT Research, Landeskrankenhaus Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria.
²² Private University of the Principality of Liechtenstein, Dorfstrasse 24. FL-9495 Triesen, Principality of Liechtenstein.
²³ Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Avda. de Séneca, 2 Ciudad Universitaria, 28040 Madrid, Spain.
²⁴ Department of Cardiology, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Klaus Torgírds vei 3, 0372 Oslo, Norway.

PMID: 31119266
DOI: 10.1093/ehjcvp/pvz016

Abstract

Oral anticoagulation in patients presenting with non-valvular atrial fibrillation and a CHA2DS2-VASc score of 1 (CHA2DS2-VASc of 2 in women) remains a challenging approach in clinical practice. Therapeutic decisions need to balance the individual benefit of reducing thromboembolic risk against the potential harm due to an increase in bleeding risk in this intermediate risk patient population. Within the current opinion statement of the European Society of Cardiology working group of cardiovascular pharmacotherapy and the European Society of Cardiology council on stroke the currently available evidence on the anti-thrombotic management in patients presenting with a CHA2DS2-VASc of 1 is summarized. Easily applicable tools for a personalized refinement of the individual thromboembolic risk in patients with atrial fibrillation and a CHA2DS2-VASc score of 1 that guide clinicians through the question whether to anticoagulate or not are provided.

Keywords: Atrial fibrillation; CHA2DS2-VASc score; Intermediate risk; Anticoagulation.

Publication types

Practice Guideline
Research Support, Non-U.S. Gov't
Review

MeSH terms

Administration, Oral
Anticoagulants / administration & dosage*
Anticoagulants / adverse effects
Atrial Fibrillation / diagnosis
Atrial Fibrillation / drug therapy*
Atrial Fibrillation / epidemiology
Clinical Decision-Making
Consensus
Decision Support Techniques
Hemorrhage / chemically induced
Humans
Risk Assessment
Risk Factors
Stroke / diagnosis
Stroke / epidemiology
Stroke / prevention & control*
Treatment Outcome

Substances

Anticoagulants