Clinical Outcomes in Non Valvular Atrial Fibrillation Patients Receiving Oral Anticoagulation Therapy using CHA2DS2-VASc and HAS-BLED Scores: A Cohort Study from Western Gujarat, India
Introduction: Non Valvular Atrial Fibrillation (NVAF) is one of the most common sustained arrhythmias. The Congestive heart failure, Hypertension, Age, Diabetes, Stroke/TIA (or Thrombembolism), Vascular disease, Age, Sex category (for CHA2DS2-VASc) score, which includes Congestive heart failure, Hyp...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2025-06-01
|
| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/21146/79380_CE[Ra1]_F(SS)_QC(AN_SS)_PF1(RI_IS)_redo_PFA_NC(IS)_PN(IS).pdf |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849433399699177472 |
|---|---|
| author | Sohilkhan Riyazkhan Pathan Bharat M Gajjar Sunilkumar Karna Kushal Pujara |
| author_facet | Sohilkhan Riyazkhan Pathan Bharat M Gajjar Sunilkumar Karna Kushal Pujara |
| author_sort | Sohilkhan Riyazkhan Pathan |
| collection | DOAJ |
| description | Introduction: Non Valvular Atrial Fibrillation (NVAF) is one of the most common sustained arrhythmias. The Congestive heart failure, Hypertension, Age, Diabetes, Stroke/TIA (or Thrombembolism), Vascular disease, Age, Sex category (for CHA2DS2-VASc) score, which includes Congestive heart failure, Hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled), Vascular disease, Age 65-74 and Sex category (female), as well as the Hypertension, Abnormal Renal/Liver function, Stroke, Bleeding history or predisposition, Labile International Normalised Ratio (INR), Elderly, Drugs/alcohol concomitantly (for HAS-BLED)-comprising Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly and Drugs/alcohol concomitantly-assists in assessing bleeding risk. However, the outcomes of NVAF have remained underreported in Gujarat, western India.
Aim: To characterise thromboembolic and bleeding risks using the CHA2DS2-VASc and HAS-BLED scores among NVAF patients receiving oral anticoagulation therapy.
Materials and Methods: This ambidirectional cohort study (retrospective and prospective) was conducted over an 11-year period (January 2014 - December 2024) at the Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital and Medical Research Centre, Karamsad, Gujarat, India, a tertiary care hospital in a rural setting. The study evaluated NVAF cases based on age, sex, co-morbidities, anticoagulation therapy {Vitamin K Antagonists (VKA) or Novel Oral Anticoagulants (NOAC)} and clinical outcomes, including stroke and bleeding events. HAS-BLED scores, treatment strategies and clinical outcomes were compared across CHA2DS2-VASc risk groups (low ≤3, intermediate 4-5 and high ≥6). Statistical analysis was performed using statistical software Statistical Analysis System (SAS) Viya (SAS Institute Inc., NC, USA). Comparisons of risk groups used the Mann-Whitney U test, Chi-square/Fisher’s-exact test and Kruskal-Wallis test as appropriate. The Cochrane-Armitage trend test evaluated anticoagulant use patterns. A p-value <0.05 was considered statistically significant.
Results: Among 347 NVAF patients, CHA2DS2-VASc scores were significantly higher in females (p<0.0001), indicating greater thromboembolic risk. Hypertension, diabetes mellitus, ischaemic heart disease, prior stroke, chronic kidney disease and heart failure were strongly associated with risk groups (p<0.0001). High-risk patients were older (median 80 vs. 61 years, p<0.0001) and had higher HAS-BLED scores (p<0.0001). NOACs were more frequently prescribed to high-risk patients than VKAs (p<0.0001), with combination antithrombotic therapy being more common among NOAC users (p=0.001). Major bleeding events, including ischaemic and haemorrhagic strokes, were significantly more frequent in high-risk patients (p<0.0001), while mortality was highest in the intermediate-risk group (25.0%, p<0.0001).
Conclusion: The present study observed sex-based differences in CHA2DS2-VASc scores and their association with thromboembolic risk. Higher scores were associated with advanced age, multiple co-morbidities, increased bleeding risk and the use of NOACs. Adverse clinical outcomes, including major bleeding, were more frequent in higher-risk groups, indicating the need for personalised anticoagulation therapy based on the patient’s bleeding and thromboembolic risk. |
| format | Article |
| id | doaj-art-ce45729dea6d40c2bfb452f97fc319b6 |
| institution | Kabale University |
| issn | 2249-782X 0973-709X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj-art-ce45729dea6d40c2bfb452f97fc319b62025-08-20T03:27:05ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2025-06-01196OC30OC3610.7860/JCDR/2025/79380.21146Clinical Outcomes in Non Valvular Atrial Fibrillation Patients Receiving Oral Anticoagulation Therapy using CHA2DS2-VASc and HAS-BLED Scores: A Cohort Study from Western Gujarat, IndiaSohilkhan Riyazkhan Pathan0Bharat M Gajjar1Sunilkumar Karna2Kushal Pujara3PhD Research Scholar, Department of Pharmacology, Bhaikaka University, Pramukhswami Medical College, Shree Krishna Hospital and Medical Research Centre, Anand, Gujarat, India.Professor, Department of Pharmacology, Bhaikaka University, Pramukhswami Medical College, Shree Krishna Hospital and Medical Research Centre, Anand, Gujarat, India.Consultant Interventional Cardiologist, Department of Cardiology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital and Medical Research Centre, Karamsad, Anand, Gujarat, India.Consultant Interventional Cardiologist, Department of Cardiology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital and Medical Research Centre, Karamsad, Anand, Gujarat, India.Introduction: Non Valvular Atrial Fibrillation (NVAF) is one of the most common sustained arrhythmias. The Congestive heart failure, Hypertension, Age, Diabetes, Stroke/TIA (or Thrombembolism), Vascular disease, Age, Sex category (for CHA2DS2-VASc) score, which includes Congestive heart failure, Hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled), Vascular disease, Age 65-74 and Sex category (female), as well as the Hypertension, Abnormal Renal/Liver function, Stroke, Bleeding history or predisposition, Labile International Normalised Ratio (INR), Elderly, Drugs/alcohol concomitantly (for HAS-BLED)-comprising Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly and Drugs/alcohol concomitantly-assists in assessing bleeding risk. However, the outcomes of NVAF have remained underreported in Gujarat, western India. Aim: To characterise thromboembolic and bleeding risks using the CHA2DS2-VASc and HAS-BLED scores among NVAF patients receiving oral anticoagulation therapy. Materials and Methods: This ambidirectional cohort study (retrospective and prospective) was conducted over an 11-year period (January 2014 - December 2024) at the Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna Hospital and Medical Research Centre, Karamsad, Gujarat, India, a tertiary care hospital in a rural setting. The study evaluated NVAF cases based on age, sex, co-morbidities, anticoagulation therapy {Vitamin K Antagonists (VKA) or Novel Oral Anticoagulants (NOAC)} and clinical outcomes, including stroke and bleeding events. HAS-BLED scores, treatment strategies and clinical outcomes were compared across CHA2DS2-VASc risk groups (low ≤3, intermediate 4-5 and high ≥6). Statistical analysis was performed using statistical software Statistical Analysis System (SAS) Viya (SAS Institute Inc., NC, USA). Comparisons of risk groups used the Mann-Whitney U test, Chi-square/Fisher’s-exact test and Kruskal-Wallis test as appropriate. The Cochrane-Armitage trend test evaluated anticoagulant use patterns. A p-value <0.05 was considered statistically significant. Results: Among 347 NVAF patients, CHA2DS2-VASc scores were significantly higher in females (p<0.0001), indicating greater thromboembolic risk. Hypertension, diabetes mellitus, ischaemic heart disease, prior stroke, chronic kidney disease and heart failure were strongly associated with risk groups (p<0.0001). High-risk patients were older (median 80 vs. 61 years, p<0.0001) and had higher HAS-BLED scores (p<0.0001). NOACs were more frequently prescribed to high-risk patients than VKAs (p<0.0001), with combination antithrombotic therapy being more common among NOAC users (p=0.001). Major bleeding events, including ischaemic and haemorrhagic strokes, were significantly more frequent in high-risk patients (p<0.0001), while mortality was highest in the intermediate-risk group (25.0%, p<0.0001). Conclusion: The present study observed sex-based differences in CHA2DS2-VASc scores and their association with thromboembolic risk. Higher scores were associated with advanced age, multiple co-morbidities, increased bleeding risk and the use of NOACs. Adverse clinical outcomes, including major bleeding, were more frequent in higher-risk groups, indicating the need for personalised anticoagulation therapy based on the patient’s bleeding and thromboembolic risk.https://jcdr.net/articles/PDF/21146/79380_CE[Ra1]_F(SS)_QC(AN_SS)_PF1(RI_IS)_redo_PFA_NC(IS)_PN(IS).pdfhaemorrhage riskrisk assessmentstroke preventionthromboembolism |
| spellingShingle | Sohilkhan Riyazkhan Pathan Bharat M Gajjar Sunilkumar Karna Kushal Pujara Clinical Outcomes in Non Valvular Atrial Fibrillation Patients Receiving Oral Anticoagulation Therapy using CHA2DS2-VASc and HAS-BLED Scores: A Cohort Study from Western Gujarat, India Journal of Clinical and Diagnostic Research haemorrhage risk risk assessment stroke prevention thromboembolism |
| title | Clinical Outcomes in Non Valvular Atrial Fibrillation Patients Receiving Oral Anticoagulation Therapy using CHA2DS2-VASc and HAS-BLED Scores: A Cohort Study from Western Gujarat, India |
| title_full | Clinical Outcomes in Non Valvular Atrial Fibrillation Patients Receiving Oral Anticoagulation Therapy using CHA2DS2-VASc and HAS-BLED Scores: A Cohort Study from Western Gujarat, India |
| title_fullStr | Clinical Outcomes in Non Valvular Atrial Fibrillation Patients Receiving Oral Anticoagulation Therapy using CHA2DS2-VASc and HAS-BLED Scores: A Cohort Study from Western Gujarat, India |
| title_full_unstemmed | Clinical Outcomes in Non Valvular Atrial Fibrillation Patients Receiving Oral Anticoagulation Therapy using CHA2DS2-VASc and HAS-BLED Scores: A Cohort Study from Western Gujarat, India |
| title_short | Clinical Outcomes in Non Valvular Atrial Fibrillation Patients Receiving Oral Anticoagulation Therapy using CHA2DS2-VASc and HAS-BLED Scores: A Cohort Study from Western Gujarat, India |
| title_sort | clinical outcomes in non valvular atrial fibrillation patients receiving oral anticoagulation therapy using cha2ds2 vasc and has bled scores a cohort study from western gujarat india |
| topic | haemorrhage risk risk assessment stroke prevention thromboembolism |
| url | https://jcdr.net/articles/PDF/21146/79380_CE[Ra1]_F(SS)_QC(AN_SS)_PF1(RI_IS)_redo_PFA_NC(IS)_PN(IS).pdf |
| work_keys_str_mv | AT sohilkhanriyazkhanpathan clinicaloutcomesinnonvalvularatrialfibrillationpatientsreceivingoralanticoagulationtherapyusingcha2ds2vascandhasbledscoresacohortstudyfromwesterngujaratindia AT bharatmgajjar clinicaloutcomesinnonvalvularatrialfibrillationpatientsreceivingoralanticoagulationtherapyusingcha2ds2vascandhasbledscoresacohortstudyfromwesterngujaratindia AT sunilkumarkarna clinicaloutcomesinnonvalvularatrialfibrillationpatientsreceivingoralanticoagulationtherapyusingcha2ds2vascandhasbledscoresacohortstudyfromwesterngujaratindia AT kushalpujara clinicaloutcomesinnonvalvularatrialfibrillationpatientsreceivingoralanticoagulationtherapyusingcha2ds2vascandhasbledscoresacohortstudyfromwesterngujaratindia |