Comparison between CHADS2 and CHA2DS2‐VASc score in a stroke cohort with atrial fibrillation. Issue 4 (27th July 2012)

• Record Type: Journal Article
• Authors: Giralt‐Steinhauer, E.; Cuadrado‐Godia, E.; Ois, Á.; Jiménez‐Conde, J.; Rodríguez‐Campello, A.; Soriano, C.; Roquer, J.
• Is Part Of: European journal of neurology. Volume 20:Issue 4(2013:Apr.)
• Page Start: 623
• Page End: 628
• Publication Date: 2012-07-27
• Subjects: Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/j.1468-1331.2012.03807.x
• Languages: English
• ISSNs: 1351-5101

Abstract

<abstract abstract-type="main" id="ene3807-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ene3807-sec-0001" sec-type="section"> <title>Background and purpose</title> <p>In patients with atrial fibrillation (AF), stroke risk stratification schemes have been developed to optimize antithrombotic treatment. The CHADS<sub>2</sub> score is frequently used but has limitations. The CHA<sub>2</sub>DS<sub>2</sub>‐VASc score improves risk prediction. Our objectives are to describe CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>‐VASc score distribution in a cohort of patients with AF and first‐ever ischaemic stroke (FIS) and to identify differences in embolic risk stratification.</p> </sec> <sec id="ene3807-sec-0002" sec-type="section"> <title>Methods</title> <p>Our cohort included 589 patients with FIS, previous modified Rankin score ≤ 3, and non‐valvular AF. We recorded demographic data, vascular risk factors, and antithrombotic pre‐treatment. The CHADS<sub>2</sub> and CHA<sub>2</sub>DS<sub>2</sub>‐VASc scores were calculated according to clinical status before stroke onset.</p> </sec> <sec id="ene3807-sec-0003" sec-type="section"> <title>Results</title> <p>In 186 (31.6%) patients, AF was previously unknown. Of patients with known AF and CHADS<sub>2</sub> ≥2 (<italic>n</italic> = 320), only 103 (32.2%) were taking anticoagulants; more than half of these patients had an INR <2. The CHADS<sub>2</sub> score placed 142 (24.1%) patients in the low–intermediate risk (score ≤ 1) category compared with 21 (3.6%) with CHA<sub>2</sub>DS<sub>2</sub>‐VASc, <italic>P</italic> < 0.001. Applying CHA<sub>2</sub>DS<sub>2</sub>‐VASc reclassified 121 (85.2%) subjects in the CHADS<sub>2</sub> low–intermediate risk category as high risk (≥2), an indication for anticoagulants. Of the 21 patients who suffered a stroke despite their low CHA<sub>2</sub>DS<sub>2</sub>‐VASc score (≤1), seven (33.3%) reported alcohol overuse, and six (28.5%) had a concomitant stroke etiology.</p> </sec> <sec id="ene3807-sec-0004" sec-type="section"> <title>Conclusions</title> <p>About 25% of FIS patients with AF had a CHADS<sub>2</sub> score ≤ 1. Despite the high CHADS<sub>2</sub> score of our population, few patients received the recommended antithrombotic treatment according to their thromboembolic risk. Using the CHA<sub>2</sub>DS<sub>2</sub>‐VASc schema significantly increased the percentage of patients indicated for anticoagulation.</p> </sec> </abstract>