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June 27, 2026EP EuropaceOpen Access

Does the effect of anticoagulation on stroke risk differ by CHA2DS2-VA score in patients with atrial fibrillation? A nationwide cohort study

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Why the study?

Does oral anticoagulation therapy reduce ischemic stroke risk differently across CHA2DS2-VA score categories in patients with atrial fibrillation?

Population

210,434 patients with new-onset atrial fibrillation and a CHA2DS2-VA score ≥ 1 in Finland (2007-2018).

Comparison

Oral anticoagulation therapy, defined in a… vs Follow-up periods without oral anticoagulation…

Design

Cohort

Key result

Oral anticoagulation therapy was associated with a lower stroke rate across CHA2DS2-VA scores 1 to 8 compared to no therapy, with the reduction stabilizing at approximately 60% for scores ≥3 (p<0.001).

Authors

LLL LeppiniemiEJE JalliVLV L J Langen

Discussion

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Overview

Low stroke rates observed with OAC in this large observational cohort; supports benefit but leaves open need for randomized confirmation.

Key Points

  • This study investigates how the effectiveness of oral anticoagulation therapy on stroke risk varies by CHA2DS2-VA score in atrial fibrillation patients.
  • Conducted a nationwide retrospective cohort study (FinACAF) in Finland from 2007 to 2018.
  • Included patients with new-onset atrial fibrillation and CHA2DS2-VA scores ≥ 1.
  • Calculated incidence rates and incidence rate ratios (IRR) of ischemic stroke during follow-up with and without oral anticoagulation therapy.
  • Stroke rates increased significantly with higher CHA2DS2-VA scores during follow-up without OAC from 0.90 to 7.78 per 100 patient years.
  • During OAC therapy, stroke rates were lower, increasing modestly from 0.79 to 3.65 per 100 patient years.
  • OAC therapy showed a statistically significant reduction in stroke rates across all CHA2DS2-VA scores, with about a 60% reduction in scores ≥ 3.

Study Design

Type

Cohort (n=210,434)

Multicenter

Yes

Structured PICO

Does oral anticoagulation therapy reduce ischemic stroke risk differently across CHA2DS2-VA score categories in patients with atrial fibrillation?

P
Population
210,434 patients in Finland with new-onset atrial fibrillation and a CHA2DS2-VA score ≥ 1, evaluated between 2007 and 2018.
E
Exposure
Oral anticoagulation (OAC) therapy (including direct oral anticoagulants and vitamin K antagonists), defined in a time-dependent manner.
C
Comparator
Follow-up periods without oral anticoagulation therapy.
O
Outcome
Incidence of ischemic stroke.hard clinical

Main Result

Effect estimate: 60% reduction

p-value: p=<0.001

Oral anticoagulation reduces stroke risk across all CHA2DS2-VA scores ≥ 1, but the relative benefit is smaller in patients with lower baseline risk scores.

Cite This Study

Leppiniemi et al. (2026) conducted a cohort in Atrial fibrillation (n=210,434). Oral anticoagulation (OAC) therapy vs. No OAC therapy was evaluated on Ischemic stroke (60% reduction, p=<0.001). Oral anticoagulation therapy was associated with a lower stroke rate across CHA2DS2-VA scores 1 to 8 compared to no therapy, with the reduction stabilizing at approximately 60% for scores ≥3 (p<0.001).

synapsesocial.com/papers/6a3f9785125782b61d86579ehttps://doi.org/10.1093/europace/euag105.405
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