CHADS2 and CHA2DS2-VASc scores can predict thromboembolic events after supraventricular arrhythmia in the critically ill patients

Should we administrate anticoagulants to critically ill patients with new onset supraventricular arrhythmias?

“…The most accurate threshold for predicting an ATE was a CHADS 2 score of ≥ 4. Using a multivariate analysis, the patient's history of stroke was the only independent predictive factor for ATEs in SVA patients [10]. We cannot, however, conclude that the CHADS 2 risk score can predict SVA-related ATEs in critically ill patients on the basis of this single-centre study.…”

“…First, risk scores were validated in a homogeneous cardiology population with non-valvular atrial fibrillation and no antithrombotic therapy. Champion et al attempted to validate these scores in a different heterogeneous population that included valvular SVA and patients with antithrombotic therapy [10]. Second, the authors report a higher incidence of SVA-related ATEs (11%) than the incidence described previously in ICUs [5].…”

“…In surgical and non-surgical critically ill patients with SVA, excluding patients in the postoperative stage of cardiac surgery, a single-centre prospective study by Champion et al evaluated for the first time the CHADS 2 and CHA 2 DS-VASc risk scores in the prediction of SVA-related ATEs [10]. Champion et al reported 16 in-hospital SVA-related ATEs in 12 of 108 (11%) patients, including five strokes, three mesenteric infarctions, two limb ischaemias, two embolic myocardial infarctions and four left atrial appendage (LAA) thrombosis.…”

“…Third, the main outcome variable was onset of an ATE, including clinical and echocardiographic (LAA thrombus detected by echocardiography) events, even though LAA thrombus itself is a major risk factor for clinical ATEs. Fourth, the decision to give anticoagulants cannot be based on a CHADS 2 score ≥ 4, given its low sensitivity (50%) and low positive predictive value (26%) in predicting SVA-related ATEs in ICU patients, notably because of their increased bleeding risk [10].…”

“…In fact, the frequency of and the required time for LAA thrombus formation in critically ill patients with SVA are possibly different in the case of cardiology patients. Champion et al reported a high incidence of ATEs and described an LAA thrombus in four of 108 patients (3.7%), although the duration of SVA was systematically < 48 h [10]. Moreover, the incidence of LAA thrombus is possibly underestimated, as TOE was not systematically performed; transthoracic echocardiography without TOE leads to LAA thrombus detection with very low sensitivity.…”