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Comparison between CHADS 2 and CHA 2 DS 2 ‐ VAS c score in a stroke cohort with atrial fibrillation
Author(s) -
GiraltSteinhauer E.,
CuadradoGodia E.,
Ois Á.,
JiménezConde J.,
RodríguezCampello A.,
Soriano C.,
Roquer 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.1468-1331.2012.03807.x
Subject(s) - medicine , atrial fibrillation , antithrombotic , cohort , stroke (engine) , cardiology , risk stratification , mechanical engineering , engineering
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 ‐ VAS c score improves risk prediction. Our objectives are to describe CHADS 2 and CHA 2 DS 2 ‐ VAS c 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 R ankin 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 ‐ VAS c 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 with 21 (3.6%) with CHA 2 DS 2 ‐ VAS c, P < 0.001. Applying CHA 2 DS 2 ‐ VAS c 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 ‐ VAS c 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 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 ‐ VAS c schema significantly increased the percentage of patients indicated for anticoagulation.