Comparison between CHADS<inf>2</inf>and CHA<inf>2</inf>DS<inf>2</inf>-VASc score in a stroke cohort with atrial fibrillation

E. Giralt-Steinhauer, E. Cuadrado-Godia, Á Ois, J. Jiménez-Conde, A. Rodríguez-Campello, C. Soriano, J. Roquer

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Abstract

Background and purpose: In patients with atrial fibrillation (AF), stroke risk stratification schemes have been developed to optimize antithrombotic treatment. The CHADS2score is frequently used but has limitations. The CHA2DS2-VASc score improves risk prediction. Our objectives are to describe CHADS2and CHA2DS2-VASc score distribution in a cohort of patients with AF and first-ever ischaemic 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 CHADS2and CHA2DS2-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 CHADS2≥2 (n = 320), only 103 (32.2%) were taking anticoagulants; more than half of these patients had an INR <2. The CHADS2score placed 142 (24.1%) patients in the low-intermediate risk (score ≤ 1) category compared with 21 (3.6%) with CHA2DS2-VASc, P < 0.001. Applying CHA2DS2-VASc reclassified 121 (85.2%) subjects in the CHADS2low-intermediate risk category as high risk (≥2), an indication for anticoagulants. Of the 21 patients who suffered a stroke despite their low CHA2DS2-VASc score (≤1), seven (33.3%) reported alcohol overuse, and six (28.5%) had a concomitant stroke etiology. Conclusions: About 25% of FIS patients with AF had a CHADS2score ≤ 1. Despite the high CHADS2score of our population, few patients received the recommended antithrombotic treatment according to their thromboembolic risk. Using the CHA2DS2-VASc schema significantly increased the percentage of patients indicated for anticoagulation. © 2012 The Author(s). European Journal of Neurology © 2012 EFNS.
Original languageEnglish
Pages (from-to)623-628
JournalEuropean Journal of Neurology
Volume20
Issue number4
DOIs
Publication statusPublished - 1 Apr 2013

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • CHA DS -VASc 2 2
  • CHADS 2
  • Stroke

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    Giralt-Steinhauer, E., Cuadrado-Godia, E., Ois, Á., Jiménez-Conde, J., Rodríguez-Campello, A., Soriano, C., & Roquer, J. (2013). Comparison between CHADS<inf>2</inf>and CHA<inf>2</inf>DS<inf>2</inf>-VASc score in a stroke cohort with atrial fibrillation. European Journal of Neurology, 20(4), 623-628. https://doi.org/10.1111/j.1468-1331.2012.03807.x