1. CHA2DS2-VASc score가 1보다 큰 경우는 embolization 고위험이며 추가적 위험 평가는 필요하지 않습니다. Non-valvular AF 환자에서 항응고제 치료를 강하게 권고합니다.
For non-valvular AF patients with a CHA2DS2-VASc score ≥2, we make a strong recommendation for oral anticoagulation. All studies have concluded that the benefit from anticoagulation significantly exceeds the risks for almost all AF patients with a CHA2DS2-VASc score ≥2
2. CHA2DS2-VASc score가 0점인 경우는 흔하지 않으며 저위험입니다. 항응고제 치료를 제안하지 않습니다.
For patients with a CHA2DS2-VASc score of 0, we suggest no oral anticoagulation. However, similar to patients with a CHA2DS2-VASc score of 1, clinical judgment will play an important role in decision making.
3. CHA2DS2-VASc score가 1인 경우는 상대적으로 넒은 범위를 갖습니다. 일부는 제안하고 다른 일부는 제안하지 않습니다. 다음 위험 인자[female sex, age between 65 and 74 years, diagnosis of hypertension, diabetes, vascular disease, heart failure] 중에 1개만 가지고 있는 경우에는 양적 위험을 고려해야 합니다. 같은 1점이지만 hypertension과 vascular disease는 risk range의 lower end에 해당하고 65-74세 나이는 higher end에 해당합니다. 즉 1점에 해당하는 위험 인자들 중에서 65-74세 나이가 다른 위험 인자들보다 더 큰 위험을 갖습니다. 고령이 가장 중요한 위험 인자입니다.
A 2015 analysis of 186,570 patients in the National Health Insurance Research Database in Taiwan not on antithrombotic therapy noted the following:
•Among nearly 13,000 men with a score of 1, the annual stroke rate was 2.75 percent, with a range from 1.96 percent per year in those whose risk factor was vascular disease to 3.5 percent for those 65 to 74 years of age.
•Among 7900 women and a CHA2DS2-VASc score of 2 (female sex plus one other risk factor), the annual rate of stroke was 2.55 percent, with a range from 1.91 whose risk factor was hypertension to 2.24 percent for those 65 to 74 years of age.
※ Female sex and vascular disease carry a lower risk than diabetes, hypertension, or age 65 to 74 years.
REF. UpToDate 2019.07.19
