Risk of Ischemic Thromboembolism in AF Patients with One Additional Risk Factor of CHA₂DS₂-VASc Score^*.

<p>Risk of Ischemic Thromboembolism in AF Patients with One Additional Risk Factor of CHA₂DS₂-VASc Score^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151485#t004fn001" target="_blank">*</a>}.</p

AnnuaI Risk of Ischemic Thromboembolism Stratified by CHA₂DS₂-VASc Score, Gender, and Age among AF patients without anticoagulants.

<p>AnnuaI Risk of Ischemic Thromboembolism Stratified by CHA₂DS₂-VASc Score, Gender, and Age among AF patients without anticoagulants.</p

Baseline Characteristics for AF Patients with One Additional Risk Factor of CHA₂DS₂-VASc Score^*.

<p>Baseline Characteristics for AF Patients with One Additional Risk Factor of CHA₂DS₂-VASc Score^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151485#t003fn001" target="_blank">*</a>}.</p

AnnuaI Risk of Ischemic thromboembolism by CHA₂DS₂-VASc Score among AF patients without anticoagulants.

<p>AnnuaI Risk of Ischemic thromboembolism by CHA₂DS₂-VASc Score among AF patients without anticoagulants.</p

Flow Chart of Study Cohort Enrollment.

<p>Patients who received treatments with warfarin or any antiplatelet agent, including aspirin and clopidogrel, were excluded from the study population. A total of 190,210 patients were finally enrolled in the study cohort with 17,595 males with CHA₂DS₂-VASc score of 1 and 9,926 females with CHA₂DS₂-VASc score of 2. Among the 17,595 male patients, there were 3,092, 9,469, and 5,034 patients in the age groups of 20 to 49, 50 to 64, and 65 to 74 years of age, respectively. Among the 9,926 female patients, there were 1,290, 5,983, and 2,653 patients in the age groups of 20 to 49, 50 to 64, and 65 to 74 years of age, respectively. There were other 10,435 males with CHA₂DS₂-VASc score of 0 and 5,984 females with CHA₂DS₂-VASc score of 1 used as the reference group, respectively. AF = atrial fibrillation; CHA₂DS₂-VASc = heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke/transient ischemic attack, vascular disease, age 65 to 74 years, female.</p

Kaplan-Meier Survival Curves in AF patients with One Additional Risk Factor of CHA₂DS₂-VASc Score.

<p><b>A.</b> Cumulative survival curves in male patients with CHA₂DS₂-VASc Score of 1 in the age groups of 20 to 49, 50 to 64, and 65 to 74 years of age, respectively. There is no difference of the cumulative risk of ischemic thromboembolism between male AF patients with CHA₂DS₂-VASc score of 1 for 20 to 49 years of age and overall patients with CHA₂DS₂-VASc score of 0. <b>B.</b> Cumulative survival curves in female patients with CHA₂DS₂-VASc Score of 2 in the age groups of 20 to 49, 50 to 64, and 65 to 74 years of age, respectively. Young female patient with CHA₂DS₂-VASc score of 2 and 20 to 49 years of age showed significantly higher cumulative risk of clincial event as compared with overall female patients with CHA₂DS₂-VASc score of 1.</p

Effect of PTU on Notch3 and gamma-secretase subunit expression in proximal and distal pulmonary arteries.

<p>Immuohistochemistry shows Notch3 expression in the proximal part (A) (scale bar: 20μm; L: vascular lumen) and the distal part of pulmonary arteries (B) (scale bar: 20μm). Notch3 in medial layer of pulmonary arteries was identified by α-SM-actin double staining for vascular SMC. The picture is a representative of 4 independent experiments.</p

Effect of PTU on pulmonary hemodynamics and pulmonary arterial hypertrophy.

<p>(A) Right ventricle systolic pressure (RVSP) in 4 different groups is shown. Pulmonary hypertension (indicated by elevated RVSP) was established 28 days after MCT injection and PTU treatment (5 mg/100g/day by gavage from day 14 to 28) reduced RVSP in MCT-treated rats. (B) Ratio of RV to LV plus septum weight (RV/LV+S) is shown. (C) Medial wall thickness of small pulmonary arteries (25–50μm) identified by α-SM-actin staining (brown staining) is shown. (D) The degree of medial wall thickness was compared among 4 groups. Each value (mean±SE [n = 6–7]) is expressed. ***p<0.001 versus control or MCT group, one-way ANOVA, bonferroni's post-test.</p

Effect of PTU on gamma-secretase subunit expression in cultured PASMCs.

<p>(A, C) After 24 hours of serum deprivation, PASMCs from control or MCT rats were treated with indicated conditions for 24 hours. Western blot shows gamma-secretase subunit expression in whole cell extraction. (B, D, F) The relative expression level of each protein is quantified by densitometry and normalized to GAPDH. (E) PASMCs from control rats were treated with indicated conditions for 24 hours. Western blot shows gamma-secretase subunit expression in whole cell extraction. Each value represents the mean±SE of 4 independent experiments. *P<0.05, **p<0.01, ***p<0.001 versus control PASMCs without PTU or scrambled peptide or Normaxia, one-way ANOVA, bonferroni’s post test.</p

Young Male Patients with Atrial Fibrillation and CHA₂DS₂-VASc Score of 1 May Not Need Anticoagulants: A Nationwide Population-Based Study

<div><p>Background</p><p>It is unclear whether oral anticoagulants are beneficial for atrial fibrillation (AF) patients with low CHA₂DS₂-VASc score. Age could be important in determining the risk of thromboembolism in low risk AF patients (CHA₂DS₂-VASc score of 1 for male or 2 for female).</p><p>Methods</p><p>The Taiwan National Health Insurance Research Database (NHIRD) was used and 27,521 AF patients with CHA₂DS₂-VASc score of 1 (male) or 2 (female) not receiving anticoagulants were acquired as the study cohort, which were classified into three age groups: 20–49, 50–64, and 65–74 years. The clinical endpoint was the occurrence of ischemic thromboembolism within one year of follow up.</p><p>Results</p><p>During the follow-up of 0.94 ± 0.19 years, 385 (2.19%) male patients experienced ischemic thromboembolism, with annual rate of 2.32%. The annual risk ranged from 1.29%, 2.43% to 2.77% for male patients aged 20–49, 50–64 and 65–74 years respectively. Of the female patients, 218 (2.20%) experienced clinical event with annual rate of 2.32%. The annual risk increased from 1.87%, 2.28% to 2.64% for female patients aged 20–49, 50–64 and 65–74 years respectively. There was no difference in risk between the male patients aged 20–49 years with CHA₂DS₂-VASc score of 1 and overall male patients with CHA₂DS₂-VASc score of 0. (<i>P</i> = 0.631) The female patients aged 20–49 years with CHA₂DS₂-VASc score of 2 was associated with a higher risk of thromboembolic events than overall female patients with CHA₂DS₂-VASc score of 1 (HR = 1.93; <i>P</i> = 0.008).</p><p>Conclusions</p><p>Age is important in determining the risk of thromboembolism in AF patients with single risk factor. In male patients <50 years old with CHA₂DS₂-VASc score of 1, the risk of ischemic thromboembolism was low. Considering the benefits and the risk of bleeding, oral anticoagulation therapy may not be favorable in these patients.</p></div