• Laurent Fauchier, Coralie Lecoq, Nicolas Clementy, Anne Bernard, Denis Angoulvant, Fabrice Ivanes, Dominique Babuty, and Gregory Y H Lip.
• Chest. 2015 Oct 1.

BackgroundIt remains uncertain whether patients with atrial fibrillation (AF) and a single additional stroke risk factor (CHA2DS2-VASc score = 1 in males, 2 in females) should be treated with oral anticoagulation (OAC). We investigated the risk of ischemic stroke, systemic embolism and death in a community-based cohort of unselected AF patients with a 0-1 stroke risk factors, based on the CHA2DS2-VASc score.MethodsAmong 8962 patients with AF seen between 2000 and 2010, 2177 (24%) had 0 or 1 additional stroke risk factor, of which 53% were prescribed OAC.ResultsOver a follow-up of 979±1158 days, 151 (7%) had a major adverse event (stroke/systemic thromboembolism/death). Prescription of OAC was not associated with a better prognosis for stroke/systemic thromboembolism/death for 'low risk' patients (ie. CHA2DS2-VASc score = 0 for men or 1 for women) [adjusted Hazard Ratio(HR) 0.68, 95% CI 0.35-1.31, p=0.25 ]. OAC use was independently associated with a better prognosis in AF patients with a single additional stroke risk factor (ie. CHA2DS2-VASc score = 1 in males, 2 in females) [adjusted HR 0.59, 95% CI 0.40-0.86, p=0.007].ConclusionAmong AF patients with one single additional stroke risk factor (CHA2DS2-VASc score = 1 in males, 2 in females), OAC use was associated with an improved prognosis for stroke/systemic thromboembolism/death.

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