Abstract 13427: Clinical Benefit of American College of Chest Physicians versus European Society of Cardiology Guidelines for Stroke Prophylaxis in Atrial Fibrillation
Background Current guidelines for anticoagulant therapy in patients with atrial fibrillation (AF) conflict with each other. The American College of Chest Physicians (ACCP) recommend no anticoagulant therapy for patients with a CHADS2 score of 0. The European Society of Cardiology (ESC) guidelines recommend anticoagulant therapy to patients with a CHADS2 score of 0 who have one or more moderate risk factor(s) (vascular disease, age 65-74, or female sex). Resolving this conflict is important because these guidelines have the potential to change anticoagulant therapy in 10% or more of the AF population.
Methods and Results Using the National Registry of Atrial Fibrillation (NRAF) II dataset of 23,657 patient records, we compared these guidelines using stroke equivalents. We calculated net stroke equivalents for patients with a CHADS2 score of 0 using a weight of 1.5 for intracranial hemorrhages (ICH). We found that warfarin therapy (as recommended by the ESC guidelines) was associated with insignificantly fewer stroke equivalents: for every 100 patients prescribed warfarin, 0.3 (95% CI -3.2 to 3.7) stroke equivalents were prevented, but hemorrhage rates were significantly higher with warfarin use (relative risk 2.8).
Conclusions As compared to the ACCP guidelines, adherence to the ESC guidelines was associated with significantly more hemorrhages and no significant reduction in stroke equivalents.
- © 2012 by American Heart Association, Inc.