Comparison between CHADS2 and CHA2DS2-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

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background and purpose: In patients with atrial fibrillation (AF), stroke risk stratification schemes have been developed to optimize antithrombotic treatment. The CHADS2 score is frequently used but has limitations. The CHA2DS2-VASc score improves risk prediction. Our objectives are to describe CHADS2 and 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 CHADS2 and 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 CHADS2 score 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 CHADS2 low-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 CHADS2 score ≤ 1. Despite the high CHADS2 score 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.

Original languageEnglish
Pages (from-to)623-628
Number of pages6
JournalEuropean Journal of Neurology
Volume20
Issue number4
DOIs
StatePublished - Apr 2013

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • CHADS
  • CHADS-VASc
  • Stroke

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