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Understand the CHA2DS2-VASc scoring system and its impact on stroke and bleeding risks. Learn how dabigatran compares to warfarin in preventing strokes and reducing bleeding, and the overall clinical benefit. Study conducted by Hisao Ogawa from Kumamoto University, Japan. Published in Chest and Annals of Internal Medicine.
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Insights of the RE-LY CHA2DS2-VASc subgroup analysisHisao OgawaKumamoto University, Japan
CHA2DS2-VASc maximum score is 9 since age may contrubute 0, 1, or 2 points Lip GY, et al., Chest 137, 263-272, 2010
CHA2DS2-VASc – overall event rates 6 5 4 3 2 1 0 0-1 634 2 3408 3 5365 4 4378 5 2566 6 1185 7 451 8-9 125 CHA2DS2-VASc No of patients Stroke and systemic embolism %/year
CHA2DS2-VASc – overall event rates 8 7 6 5 4 3 2 1 0 0-1 634 2 3408 3 5365 4 4378 5 2566 6 1185 7 451 8-9 125 CHA2DS2-VASc No of patients Major (including intracranial) bleeding %/year Intracranial Major
The Net Clinical Benefit of warfarin by CHADS2score CHADS2score 2.22 4-6 0.58 3.75 2.07 3 1.21 2.79 0.97 2 0.43 1.41 0.19 1 -0.27 0.45 -0.11 0 -0.44 -0.20 -1 -0.5 0 0.5 1 1.5 2 2.5 3 3.5 Worse with Warfarin Better with Warfarin Singer DE, et al. : Ann Intern Med. 151, 297-305, 2009
Stroke and systemic embolism (SE) D110 BID vs. warfarin D150 BID vs. warfarin Annual rate, % CHA2DS2-VASc D110 D150 Warfarin 0.8 0.9 0.5 ≤2 3 1.4 1.3 0.8 2.0 4 1.6 1.0 2.8 5-9 2.4 2.1 p(inter)=0.60 p(inter)=0.81 0.50 1.00 1.50 0.50 1.00 1.50 Dabigatran better Warfarin better Dabigatran better Warfarin better
Intracranial bleeding D110 BID vs. warfarin D150 BID vs. warfarin Annual rate, % CHA2DS2-VASc D110 D150 Warfarin ≤2 0.15 0.11 0.38 3 0.16 0.32 0.76 4 0.29 0.21 1.04 5-9 0.32 0.63 0.84 p(inter)=0.09 p(inter)=0.77 0.50 1.00 1.50 0.50 1.00 1.50 Warfarin better Dabigatran better Warfarin better Dabigatran better
Conclusion • Increasing CHA2DS2-VASc scores are associated with raised risks for stroke and bleeding, • Irrespective of CHA2DS2-VASc scores dabigatran 150 mg was superior and dabigatran 110 mg non-inferior to warfarin for stroke prevention • Both dabigatran doses reduce intracranial bleeding irrespective of CHA2DS2-VASc scores Dabigatran has a favorable benefit risk profile compared to warfarin in patients with low to high CHA2DS2-VASc scores