New score for predicting thromboembolic events in patients with atrial fibrillation using direct oral anticoagulants

Area of Science:

• Cardiology
• Neurology
• Pharmacology

Background:

• Thrombotic events in atrial fibrillation patients on direct oral anticoagulants (DOACs) require better risk stratification.
• Current risk factors for thromboembolism in this population are not fully understood.
• A validated predictive tool is needed for clinical assessment.

Purpose of the Study:

• To identify independent risk factors for thromboembolism in patients with atrial fibrillation treated with DOACs.
• To develop and externally validate a predictive model for thromboembolism.
• To provide a clinical tool for assessing thromboembolism risk in patients on DOACs.

Main Methods:

• A national multicenter retrospective study involving 3263 patients with atrial fibrillation on DOACs.
• Logistic regression was used to build a prediction model in a development cohort (n=2390).
• External validation and calibration were performed using AUC and the Hosmer-Lemeshow test on a separate cohort (n=873).

Main Results:

• Heavy drinking, hypertension, prior stroke/transient ischemic attack (TIA), and cerebral infarction during hospitalization were identified as independent risk factors.
• The developed Alfalfa-TE risk score demonstrated good discriminatory power in the development cohort (AUC=0.84).
• The model showed good discriminatory power (AUC=0.74) and calibration (Hosmer-Lemeshow P=0.649) in the external validation cohort.

Conclusions:

• The Alfalfa-TE risk score, based on four key factors, is a validated predictive model for thromboembolism in atrial fibrillation patients on DOACs.
• This model demonstrates good predictive value and may aid in reducing thromboembolic events.
• The Alfalfa-TE score offers a valuable tool for clinical risk assessment in this patient group.