RELY CHADS-VASc

Insights of the RE-LY CHA2DS2-VASc
subgroup analysis
Hisao Ogawa
Kumamoto University, Japan
CHA2DS2-VASc
Risk factor
score
C
Congestive heart failure/LV dysfunction
1
H
Hypertension
1
A2
Age ≥75y
2
D
Diabetes mellitus
1
S2
Stroke/TIA/TE
2
V
Vascular disease (prior myocardial infarction,
peripheral artery disease, or aortic plaque)
1
A
Age 65-74y
1
Sc
Sex category (ie female gender)
1
Maximum Score
9
maximum score is 9 since age may contrubute 0, 1, or 2 points
Lip GY, et al., Chest 137, 263-272, 2010
CHA2DS2-VASc – overall event rates
Stroke and systemic embolism
%/year
6
5
4
3
2
1
0
CHA2DS2-VASc
0-1
2
3
4
5
6
7
8-9
No of patients
634
3408
5365
4378
2566
1185
451
125
CHA2DS2-VASc – overall event rates
%/year
8
Major (including intracranial) bleeding
Intracranial
7
Major
6
5
4
3
2
1
0
CHA2DS2-VASc
0-1
2
3
4
5
6
7
8-9
No of patients
634
3408
5365
4378
2566
1185
451
125
The Net Clinical Benefit of warfarin by CHADS2 score
CHADS2 score
4-6
3
2.07
1.21
2
0.97
0.43
1
0
2.22
0.58
-0.27
-0.44
-1
0.19
-0.11
-0.5
Worse with Warfarin
0
3.75
2.79
1.41
0.45
-0.20
0.5
1
1.5
2
2.5
3
3.5
Better with Warfarin
Singer DE, et al. : Ann Intern Med. 151, 297-305, 2009
Stroke and systemic embolism (SE)
D110 BID vs. warfarin
CHA2DS2-VASc
D150 BID vs. warfarin
Annual rate, %
D110
D150
Warfarin
≤2
3
0.9
0.5
0.8
1.3
0.8
1.4
4
1.6
1.0
2.0
5-9
2.4
2.1
2.8
p(inter)=0.60
p(inter)=0.81
0.50
1.00
Dabigatran
better
1.50
Warfarin
better
0.50
1.00
Dabigatran
better
1.50
Warfarin
better
Intracranial bleeding
CHA2DS2-VASc
≤2
3
4
5-9
D110 BID vs. warfarin
D150 BID vs. warfarin
p(inter)=0.77
p(inter)=0.09
Annual rate, %
D110
D150
Warfarin
0.15
0.16
0.11
0.32
0.38
0.76
0.29
0.32
0.21
0.63
1.04
0.84
0.50
1.00
Dabigatran
better
1.50
Warfarin
better
0.50
1.00
Dabigatran
better
1.50
Warfarin
better
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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