Use of the SAMe-TT2R2 Score to Predict Good Anticoagulation Control with Warfarin in Chinese Patients with Atrial Fibrillation: Relationship to Ischemic Stroke Incidence

Abstract Background The association of individual omega-3 fatty acids (n-3 FAs) with ischemic stroke remains unclear. Experimental data strongly suggest that n-3 FAs reduce ischemic stroke due to their anti-thrombotic and anti-inflammatory properties. Yet, recent clinical trials yielded mixed results. While marine n-3 FA supplementation (1g/day) did not reduce stroke, icosapent ethyl, a purified eicosapentaenoic acid (EPA) ethyl ester (4g/day), significantly reduced stroke incidence in patients at high cardiovascular risk. In the current study, we examined the association of fish-derived EPA, docosapentaenoic acid (DPA), docosahexaenoic acid (DHA) and the plant-derived alpha-linolenic acid (ALA) with the prevalence of ischemic brain infarcts in elderly patients with atrial fibrillation. Methods In this cross-sectional analysis of the Swiss atrial fibrillation (swissAF) cohort study, we determined baseline whole blood n-3 FAs by gas chromatography according to the HS-Omega-3 Index methodology in 1665 patients aged ≥65 years with atrial fibrillation. Large non-cortical and cortical infarcts (LNCCI) were assessed by brain MRI. Total and individual n-3 FAs were correlated with the prevalence of LNCCI in a logit model with continuous factors. Analyses were adjusted for sex, age, body mass index, smoking, alcohol intake, family history of cardiovascular disease and atrial fibrillation, physical activity, hypertension, diabetes, chronic kidney disease, prior stroke, prior transient ischemic attack, aspirin, anticoagulation and type of atrial fibrillation. Results A total of 373 patients with LNCCI (22.4%) were identified. After adjustment, lower risk of LNCCI was associated with higher EPA (odds ratio [OR] 0.50 per increase of one percentage point EPA, 95% confidence interval [CI] 0.28–0.88) and a higher risk was detected with DPA (OR 2.39, 95% CI 1.43–4.01). No statistically significant association was detected with DHA (OR 1.13, 95% CI 0.94–1.35), ALA (OR 0.83, 95% CI 0.23–2.95) or total n-3 FAs (OR 1.03, 95% CI 0.92–1.16). Conclusions Higher levels of EPA are associated with a lower prevalence of ischemic infarcts in aged patients with atrial fibrillation. Unexpectedly, DPA shows a direct correlation with ischemic infarcts. This study demonstrates that individual n-3 FAs may differentially affect stroke risk and that supplementation of EPA may be an interesting strategy to prevent ischemic stroke in atrial fibrillation patients. Acknowledgement/Funding Swiss National Science Foundation

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Comments on “A simple and easily implemented risk model to predict 1-year ischemic stroke and systemic embolism in Chinese patients with atrial fibrillation”

Chinese Medical Journal ◽

10.1097/cm9.0000000000001608 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Yi-Gang Li ◽

Chang-Qi Gong

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Risk Model ◽

Chinese Patients ◽

Systemic Embolism

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Integrating genotypes in the SAMe-TT 2 R 2 score for the prediction of anticoagulation control in Chinese patients with atrial fibrillation on warfarin

International Journal of Cardiology ◽

10.1016/j.ijcard.2017.04.092 ◽

2017 ◽

Vol 241 ◽

pp. 358-363 ◽

Cited By ~ 4

Author(s):

Jia Liu ◽

Nina Wang ◽

Liuan Qin ◽

Jun Liu ◽

Shaozhi Xi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chinese Patients ◽

Anticoagulation Control

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Chromosomal abnormalities and atrial fibrillation and ischemic stroke incidence: a nationwide population-based study

Scientific Reports ◽

10.1038/s41598-020-72678-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Jun Hwan Cho ◽

Eue-Keun Choi ◽

In-Ki Moon ◽

Jin- Hyung Jung ◽

Kyung-Do Han ◽

...

Keyword(s):

Atrial Fibrillation ◽

Down Syndrome ◽

Ischemic Stroke ◽

Turner Syndrome ◽

Chromosomal Abnormalities ◽

Klinefelter Syndrome ◽

Control Group ◽

Stroke Incidence ◽

Cox Regression Analysis ◽

Increased Risk

Abstract There is a paucity of information as to whether chromosomal abnormalities, including Down Syndrome, Turner Syndrome, and Klinefelter Syndrome, have an association with atrial fibrillation (AF) and ischemic stroke development. Data from 3660 patients with Down Syndrome, 2408 with Turner Syndrome, and 851 with Klinefelter Syndrome without a history of AF and ischemic stroke were collected from the Korean National Health Insurance Service (2007–2014). These patients were followed-up for new-onset AF and ischemic stroke. Age- and sex-matched control subjects (at a ratio of 1:10) were selected and compared with the patients with chromosomal abnormalities. Down Syndrome patients showed a higher incidence of AF and ischemic stroke than controls. Turner Syndrome and Klinefelter Syndrome patients showed a higher incidence of AF than did the control group, but not of stroke. Multivariate Cox regression analysis revealed that three chromosomal abnormalities were independent risk factors for AF, and Down Syndrome was independently associated with the risk of stroke. In conclusion, Down Syndrome, Turner Syndrome, and Klinefelter Syndrome showed an increased risk of AF. Down Syndrome patients only showed an increased risk of stroke. Therefore, AF surveillance and active stroke prevention would be beneficial in patients with these chromosomal abnormalities.

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Time Trends of Ischemic Stroke Incidence and Mortality in Patients Diagnosed With First Atrial Fibrillation in 1980 to 2000

Stroke ◽

10.1161/01.str.0000185927.63746.23 ◽

2005 ◽

Vol 36 (11) ◽

pp. 2362-2366 ◽

Cited By ~ 67

Author(s):

Yoko Miyasaka ◽

Marion E. Barnes ◽

Bernard J. Gersh ◽

Stephen S. Cha ◽

James B. Seward ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Time Trends ◽

Stroke Incidence ◽

Incidence And Mortality

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The Association of Atrial Fibrillation and Ischemic Stroke in Patients on Hemodialysis: A Competing Risk Analysis

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358119878719 ◽

2019 ◽

Vol 6 ◽

pp. 205435811987871 ◽

Cited By ~ 4

Author(s):

Mark Findlay ◽

Rachael MacIsaac ◽

Mary Joan MacLeod ◽

Wendy Metcalfe ◽

Manish M. Sood ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Stroke Risk ◽

Competing Risk ◽

Discharge Data ◽

Stroke Incidence ◽

Risk Of Death ◽

Hazards Model ◽

The Relationship

Background: Stroke is common in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD) and associated with high mortality rate. In the general population, atrial fibrillation (AF) is a major risk factor for stroke and therapeutic anticoagulation is associated with risk reduction, whereas in ESRD the relationship is less clear. Objective: The purpose of this study is to demonstrate the influence of AF on stroke rates and probability in those on HD following competing risk analyses. Design: A national record linkage cohort study. Setting: All renal and stroke units in Scotland, UK. Patients: All patients with ESRD receiving HD within Scotland from 2005 to 2013 (follow-up to 2015). Measurements: Demographic, clinical, and laboratory data were linked between the Scottish Renal Registry, Scottish Stroke Care Audit, and hospital discharge data. Stroke was defined as a fatal or nonfatal event and mortality derived from national records. Methods: Associations for stroke were determined using competing risk models: the cause-specific hazards model and the Fine and Gray subdistribution hazards model accounting for the competing risk of death in models of all stroke, ischemic stroke, and first-ever stroke. Results: Of 5502 patients treated with HD with 12 348.6-year follow-up, 363 (6.6%) experienced stroke. The stroke incidence rate was 26.7 per 1000 patient-years. Multivariable regression on the cause-specific hazard for stroke demonstrated age, hazard ratio (HR) (95% confidence interval [CI]) = 1.04 (1.03-1.05); AF, HR (95% CI) = 1.88 (1.25-2.83); prior stroke, HR (95% CI) = 2.29 (1.48-3.54), and diabetes, HR (95% CI) = 1.92 (1.45-2.53); serum phosphate, HR (95% CI) = 2.15 (1.56-2.99); lower body weight, HR (95% CI) = 0.99 (0.98-1.00); lower hemoglobin, HR (95% CI) = 0.88 (0.77-0.99); and systolic blood pressure (BP), HR (95% CI) = 1.01 (1.00-1.02), to be associated with an increased stroke rate. In contrast, the subdistribution HRs obtained following Fine and Gray regression demonstrated that AF, weight, and hemoglobin were not associated with stroke risk. In both models, AF was significantly associated with nonstroke death. Limitations: Our analyses derive from retrospective data sets and thus can only describe association not causation. Data on anticoagulant use are not available. Conclusions: The incidence of stroke in HD patients is high. The competing risk of “prestroke” mortality affects the relationship between AF and risk of future stroke. Trial designs for interventions to reduce stroke risk in HD patients, such as anticoagulation for AF, should take account of competing risks affecting associations between risk factors and outcomes.

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Quality of oral anticoagulation control in Chinese patients with non-valvular atrial fibrillation: a prospective controlled study

Current Medical Research and Opinion ◽

10.1080/03007995.2020.1796611 ◽

2020 ◽

Vol 36 (9) ◽

pp. 1433-1439

Author(s):

Yaqian Li ◽

Jingjing Yu ◽

Yun Kuang ◽

Chengkun Wu ◽

Liu Yang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulation ◽

Chinese Patients ◽

Controlled Study ◽

Anticoagulation Control ◽

Prospective Controlled Study

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Comparison of Safety and Efficacy of Warfarin Versus Rivaroxaban in Northern Chinese Patients With Different CHA2DS2-VASc Score

10.21203/rs.3.rs-486483/v1 ◽

2021 ◽

Author(s):

Shiwei Xu ◽

Yuanyuan Guo ◽

Xianghui Li ◽

zengxiang dong ◽

Xin Hai

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Treated Group ◽

The Other ◽

Chinese Patients ◽

Economic Factors ◽

Safety And Efficacy ◽

Northern Chinese ◽

One Year

Abstract Purpose: Although many researches have indicated the anticoagulant effect of warfarin and rivaroxaban in atrial fibrillation (AF) patients, the comparison of these drugs on safety and efficacy in northern Chinese patients with different CHA2DS2-VASc Score is unclear. We aim to compare the safety and efficacy of warfarin versus rivaroxaban in northern Chinese AF patients with different CHA2DS2-VASc Score subgroups. Methods: 387 AF patients were recruited in the study. Of these, one group patients (n=194) were receiving warfarin, and the other group patients (n=193) were receiving rivaroxaban. Follow-up data were collected for one year, which included adherence, bleeding and ischemic stroke (IS) events. Results: There was better adherence in rivaroxaban-treated group than warfarin-treated group. The events of bleeding decreased with increased score in warfarin-treated group. Patients with score 2-3, had better adherence and less stroke events in warfarin-treated group. The events of bleeding and stroke was not significantly different in rivaroxaban-treated group at different score. Conclusions: We found that there was better adherence and less bleeding and stroke events in rivaroxaban-treated group than warfarin-treated group with different CHA2DS2-VASc score. There is better choice for northern Chinese patients to select rivaroxaban in the anticoagulative treatment of AF, regardless of economic factors.

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Abstract 19565: SAMeTT2R2 Scores Predict Stroke Risk After Initiation of Vitamin K Antagonist Therapy for Atrial Fibrillation: a Real-world Practice Study

Circulation ◽

10.1161/circ.130.suppl_2.19565 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Carlos Martinez ◽

Anja Katholing ◽

Stephan Reitbrock ◽

Gregory Y Lip ◽

Ben Freedman

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Real World ◽

Stroke Risk ◽

Vitamin K Antagonist ◽

Practice Research ◽

Rank Test ◽

Clinical Practice Research Datalink ◽

Stroke Incidence ◽

Anticoagulation Control

Introduction: Quality and duration of anticoagulation reflected by high proportion of Time in Therapeutic INR range (TTR) is associated with reduced thrombo-embolic and bleeding events in atrial fibrillation (AF). SAMeTT2R2, a novel score incorporating age, sex, ethnicity, smoking, co-morbidities, and interacting drugs, predicts inadequate anticoagulation control (TTR <0.6) after commencing Vitamin K Antagonist (VKA) for AF, with scores ≥2 suggested as a cut-off to predict inadequate control. Aims: To determine whether SAMeTT2R2 score ≥2 at VKA inception is associated with an increased stroke risk in real-world practice. Methods: A cohort of VKA-naïve patients with incident non-valvular AF between 2001 - 2010 was formed from a large UK primary care database (Clinical Practice Research Datalink, CPRD) with linkage to hospital discharges, and death registry. SAMeTT2R2 score was calculated in a subset of 4468 in whom VKA treatment was initiated within 90 days of AF diagnosis, and scores 0-1, ≥2 were related to 3-year stroke incidence. Competing risk analysis accounting for death was performed to compare the risk of stroke between the two groups in an intention-to-treat analysis. Results: Of 4468 patients with incident AF commenced on VKA (mean age 70.7, 41.2% female), 3422 (76.6%) had a SAMeTT2R2 score of 0-1, and 1046 (23.4%) a score of ≥2. During 3-years 138 patients had a stroke and 58 of these occurred in the year following AF. Cumulative risk estimates for stroke in patients with scores ≥2 compared to 0-1 were significantly increased at 1, 2 and 3 years (log rank test, p<0.01)(Figure). The proportion with TTR≥0.6 was 37.1% for scores ≥2 compared to 44.1% for scores 0-1 (p<0.01). Conclusions: SAMeTT2R2 scores ≥2 predict increased stroke risk in the 3 years following incident AF in patients commenced on VKA treatment. These findings suggest that patients with high SAMeTT2R2 scores may require intensified anticoagulation control or use of oral non-VKA anticoagulants.

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