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Comparison between CHADS (2) and CHA (2) DS (2) -VASc score in a stroke cohort with atrial fibrillation.
MedLine Citation:
PMID:  22834861     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: In patients with atrial fibrillation (AF), stroke risk stratification schemes have been developed to optimize antithrombotic treatment. The CHADS (2) score is frequently used but has limitations. The CHA (2) DS (2) -VASc score improves risk prediction. Our objectives are to describe CHADS (2) and CHA (2) DS (2) -VASc score distribution in a cohort of patients with AF and first-ever ischemic stroke (FIS) and to identify differences in embolic risk stratification. METHODS: 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 (2) and CHA (2) DS (2) -VASc scores were calculated according to clinical status before stroke onset. RESULTS: In 186 (31.6%) patients, AF was previously unknown. Of patients with known AF and CHADS (2) ≥2 (n = 320), only 103 (32.2%) were taking anticoagulants; more than half of these patients had an INR <2. The CHADS (2) score placed 142 (24.1%) patients in the low-intermediate risk (score ≤ 1) category compared to 21 (3.6%) with CHA (2) DS (2) -VASc, P < 0.001. Applying CHA (2) DS (2) -VASc reclassified 121 (85.2%) subjects in the CHADS (2) low-intermediate risk category as high risk (≥2), an indication for anticoagulants. Of the 21 patients who suffered a stroke despite their low CHA (2) DS (2) -VASc score (≤1), 7 (33.3%) reported alcohol overuse, and 6 (28.5%) had a concomitant stroke etiology. CONCLUSIONS: About 25% of FIS, patients with AF had a CHADS (2) score ≤ 1. Despite the high CHADS (2) score of our population, few patients received the recommended antithrombotic treatment according to their thromboembolic risk. Using the CHA (2) DS (2) -VASc schema significantly increased the percentage of patients indicated for anticoagulation.
Authors:
E Giralt-Steinhauer; E Cuadrado-Godia; A Ois; J Jiménez-Conde; A Rodríguez-Campello; C Soriano; J Roquer
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-27
Journal Detail:
Title:  European journal of neurology : the official journal of the European Federation of Neurological Societies     Volume:  -     ISSN:  1468-1331     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9506311     Medline TA:  Eur J Neurol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 The Author(s) European Journal of Neurology © 2012 EFNS.
Affiliation:
Neurovascular Research Group, IMIM-Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
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