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Insights of the RE-LY CHA 2 DS 2 -VASc subgroup analysis Hisao Ogawa Kumamoto University, Japan

Insights of the RE-LY CHA 2 DS 2 -VASc subgroup analysis Hisao Ogawa Kumamoto University, Japan. CHA 2 DS 2 -VASc. maximum score is 9 since age may contrubute 0, 1, or 2 points. Lip GY, et al., Chest 137, 263-272, 2010. CHA 2 DS 2 -VASc – overall event rates. 6. 5. 4. 3. 2. 1. 0.

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Insights of the RE-LY CHA 2 DS 2 -VASc subgroup analysis Hisao Ogawa Kumamoto University, Japan

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  1. Insights of the RE-LY CHA2DS2-VASc subgroup analysisHisao OgawaKumamoto University, Japan

  2. CHA2DS2-VASc maximum score is 9 since age may contrubute 0, 1, or 2 points Lip GY, et al., Chest 137, 263-272, 2010

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

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