Stroke due to atrial fibrillation in a population‐based stroke registry (Ludwigshafen Stroke Study) CHADS2, CHA2DS2‐VASc score, underuse of oral anticoagulation, and implications for preventive measures. Issue 1 (12th July 2012)

• Record Type: Journal Article
• Authors: Palm, F.; Kleemann, T.; Dos Santos, M.; Urbanek, C.; Buggle, F.; Safer, A.; Hennerici, M. G.; Becher, H.; Zahn, R.; Grau, A. J.
• Is Part Of: European journal of neurology. Volume 20:Issue 1(2013:Jan.)
• Page Start: 117
• Page End: 123
• Publication Date: 2012-07-12
• Subjects: Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/j.1468-1331.2012.03804.x
• Languages: English
• ISSNs: 1351-5101

Abstract

<abstract abstract-type="main" xml:lang="en" id="ene3804-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ene3804-sec-0001" sec-type="section"> <title>Background and purpose</title> <p>Atrial fibrillation (AF) is amongst the most important etiologies of ischaemic stroke. In a population‐based stroke registry, we tested the hypothesis of low adherence to current guidelines as a main cause of high rates of AF‐associated stroke.</p> </sec> <sec id="ene3804-sec-0002" sec-type="section"> <title>Methods</title> <p>Within the Ludwigshafen Stroke Study (LuSSt), a prospective ongoing population‐based stroke register, we analyzed all patients with a first‐ever ischaemic stroke (FEIS) owing to AF in 2006 and 2007. We determined whether AF was diagnosed before stroke and assessed pre‐stroke CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>‐VASc scores.</p> </sec> <sec id="ene3804-sec-0003" sec-type="section"> <title>Results</title> <p>In total, 187 of 626 patients with FEIS suffered from cardioembolic stroke owing to AF, which was newly diagnosed in 57 (31%) patients. Retrospective pre‐stroke risk stratification according to CHADS<sub>2</sub> score indicated low/intermediate risk in 34 patients (18%) and high risk (CHADS<sub>2</sub> ≥ 2) in 153 patients (82%). Application of CHA<sub>2</sub>DS<sub>2</sub>‐VASc score reduced number of patients at low/intermediate risk (CHA<sub>2</sub>DS<sub>2</sub>‐VASc score 0–1) to five patients (2.7%). In patients with a CHADS<sub>2</sub> score ≥ 2 and known AF (<italic>n</italic> = 106) before stroke, 38 (36%) were on treatment with vitamin K antagonists on admission whilst only in 16 patients (15%) treatment was in therapeutic range.</p> </sec> <sec id="ene3804-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Our study strongly supports the hypothesis that underuse of oral anticoagulants in high‐risk patients importantly contributes to AF‐associated stroke. CHA<sub>2</sub>DS<sub>2</sub>‐VASc score appears to be a more valuable risk stratification tool than CHADS<sub>2</sub> score. Preventive measures should focus on optimizing pre‐stroke detection of AF and better implementation of present AF‐guidelines with respect to anticoagulation therapy.</p> </sec> </abstract>