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Atrial fibrillation (AF) is the most clinically prevalent tachyarrhythmia 1,2) . AF is a potential risk factor for stroke, and AF-associated strokes are often severe, resulting in disability or death 3−6) . The CHADS2(Congestive heart failure, Hypertension, AgeB75, Diabetes, Stroke [doubled]) score is simple and is useful for risk stratification of stroke in nonvalvular AF(NVAF) patients 7) . Anticoagulant therapy with an oral anticoagulant (OAC)reduces the risk of AF-related stroke 8) . The vitamin K antagonist(VKA)warfarin was the most commonly used OAC in Japan prior to the availability of non-vitamin K antagonist oral anticoagulants(NOACs), and remains an important OAC for the prevention of stroke in NVAF patients. Warfarin has a risk of serious bleeding complications and has been indicated for patients with CHADS2 scoresB2. Indeed, the AnTicoagulation and Risk Factors in Atrial Fibrillation(ATRIA) study showed that a net clinical benefit of warfarin therapy (balancing ischemic stroke against intracranial hemorrhage)was observed in patients with a CHADS2 scoreB2 9) . On the other hand, the bleeding risk is thought to outweigh the benefit of stroke reduction in patients with CHADS2 scores of 0-1. The J-RHYTHM registry, a multicenter, contemporary, prospective observational study with a 2-year follow-up, which included 7,384 Japanese patients with NVAF, has reported that 50% of the subjects had CHADS2 scores of 0-1 and that 82% had taken warfarin 10) . Stroke risk factors also confer an increased risk of bleeding, because some of the risk factors for stroke and bleeding overlap. The presence of these risk factors may increase the risk of the development of a combined stroke. Thus, patients with low CHADS2 scores have a low bleeding risk. Post-hoc analysis of the Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events(ACTIVE-W) study reported a greater benefit associated with OAC(warfarin) compared with clopidogrel plus aspirin, regardless of whether the patientsʼ baseline CHADS2 score fell in the range of 0 to 1 11) . Recent cohort studies showed that VKA use was associated with a lower stroke rate in patients with CHADS2 score of 1, compared with antiplatelet or no antithrombotic therapy 10,12,13) . 臨床薬理 Jpn J Clin Pharmacol Ther 2015; 46(4): 191-197 191

rinshou yakuri/rinshō yakuri

&lt;b&gt;Clinical Outcomes and Anticoagulant Intensity in Japanese Nonvalvular Atrial Fibrillation Patients &amp;ge;65 Years of Age with a CHADS&lt;sub&gt;2&lt;/sub&gt; Score 0-1 and Taking Warfarin&lt;/b&gt;