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Background  It is unclear whether oral anticoagulants are beneficial for atrial fibrillation (AF) patients with low CHA 2 DS 2 -VASc score. Age could be important in determining the risk of thromboembolism in low risk AF patients (CHA 2 DS 2 -VASc score of 1 for male or 2 for female).    Methods  The Taiwan National Health Insurance Research Database (NHIRD) was used and 27,521 AF patients with CHA 2 DS 2 -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.    Results  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 CHA 2 DS 2 -VASc score of 1 and overall male patients with CHA 2 DS 2 -VASc score of 0. ( P  = 0.631) The female patients aged 20–49 years with CHA 2 DS 2 -VASc score of 2 was associated with a higher risk of thromboembolic events than overall female patients with CHA 2 DS 2 -VASc score of 1 (HR = 1.93;  P  = 0.008).    Conclusions  Age is important in determining the risk of thromboembolism in AF patients with single risk factor. In male patients <50 years old with CHA 2 DS 2 -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.

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