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Stroke due to atrial fibrillation in a population‐based stroke registry ( L udwigshafen Stroke Study) CHADS 2 , CHA 2 DS 2 ‐ VAS c score, underuse of oral anticoagulation, and implications for preventive measures
Author(s) -
Palm F.,
Kleemann T.,
Dos Santos M.,
Urbanek C.,
Buggle F.,
Safer A.,
Hennerici M. G.,
Becher H.,
Zahn R.,
Grau A. J.
Publication year - 2013
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2012.03804.x
Subject(s) - medicine , atrial fibrillation , stroke (engine) , population , etiology , cardiology , mechanical engineering , environmental health , engineering
Background and purpose 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. Methods Within the L udwigshafen Stroke Study (Lu SS t), 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 2 and CHA 2 DS 2 ‐ VAS c scores. Results 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 2 score indicated low/intermediate risk in 34 patients (18%) and high risk ( CHADS 2 ≥ 2) in 153 patients (82%). Application of CHA 2 DS 2 ‐ VAS c score reduced number of patients at low/intermediate risk ( CHA 2 DS 2 ‐ VAS c score 0–1) to five patients (2.7%). In patients with a CHADS 2 score ≥ 2 and known AF ( n = 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. Conclusions Our study strongly supports the hypothesis that underuse of oral anticoagulants in high‐risk patients importantly contributes to AF ‐associated stroke. CHA 2 DS 2 ‐ VAS c score appears to be a more valuable risk stratification tool than CHADS 2 score. Preventive measures should focus on optimizing pre‐stroke detection of AF and better implementation of present AF ‐guidelines with respect to anticoagulation therapy.