Net clinical benefit of oral anticoagulants in Korean atrial fibrillation patients with low to intermediate stroke risk: A report from the Clinical Survey on Stroke Prevention in patients with Atrial Fibrillation (CS-SPAF)

BackgroundThe balance of stroke risk reduction and potential bleeding risk associated with antithrombotic treatment (ATT) remains unclear in atrial fibrillation (AF) at non-gender CHA(2)DS(2)-VASc scores 0-1. A net clinical benefit (NCB) analysis of ATT may guide stroke prevention strategies in AF with non-gender CHA(2)DS(2)-VASc scores 0-1. MethodsThis multi-center cohort study evaluated the clinical outcomes of treatment with a single antiplatelet (SAPT), vitamin K antagonist (VKA), and non-VKA oral anticoagulant (NOAC) in non-gender CHA(2)DS(2)-VASc score 0-1 and further stratified by biomarker-based ABCD score (Age [>= 60 years], B-type natriuretic peptide [BNP] or N-terminal pro-BNP [>= 300 pg/mL], creatinine clearance [<50 mL/min], and dimension of the left atrium [>= 45 mm]). The primary outcome was the NCB of ATT, including composite thrombotic events (ischemic stroke, systemic embolism, and myocardial infarction) and major bleeding events. ResultsWe included 2465 patients (age 56.2 +/- 9.5 years; female 27.0%) followed-up for 4.0 +/- 2.8 years, of whom 661 (26.8%) were treated with SAPT; 423 (17.2%) with VKA; and 1040 (42.2%) with NOAC. With detailed risk stratification using the ABCD score, NOAC showed a significant positive NCB compared with the other ATTs (SAPT vs. NOAC, NCB 2.01, 95% confidence interval [CI] 0.37-4.66; VKA vs. NOAC, NCB 2.38, 95% CI 0.56-5.40) in ABCD score >= 1. ATT failed to show a positive NCB in patients with truly low stroke risk (ABCD score = 0). ConclusionsIn the Korean AF cohort at non-gender CHA(2)DS(2)-VASc scores 0-1, NOAC showed significant NCB advantages over VKA or SAPT with ABCD score >= 1.