Implications of CHA₂DS₂-VASc Score in Stroke Patients with Atrial Fibrillation: An Analysis of 938 Korean Patients

Abstract

Background and Aims: The aim of this study was to investigate the stroke mechanisms and associated conditions influencing the decision regarding stroke thromboprophylaxis in patients with atrial fibrillation (AF) plus ischemic stroke, according to the CHA₂DS₂-VASc score. Methods: We evaluated 938 consecutive patients with a diagnosis of AF plus transient ischemic attack/ischemic stroke. Based on the CHA₂DS₂-VASc scores, patients were stratified as score 0 or 1 (n = 151), score 2 (n = 146), score 3 (n = 213), score 4 (n = 185), or score ≥5 (n = 243). Results: Patients with a higher CHA₂DS₂-VASc score were more likely to have noncardioembolic stroke mechanism (p = 0.001). Large-artery atherosclerosis causing stenosis >50% was more frequently observed in the high CHA₂DS₂-VASc group (p < 0.001). Coronary artery disease and the use of antiplatelet agents were more prevalent in the higher group (p < 0.001). A high CHA₂DS₂-VASc score was associated with a higher frequency of cerebral microbleeds and a higher Fazekas grade for leukoaraiosis (p < 0.001). The HAS-BLED score was correlated with the CHA₂DS₂-VASc score (γ = 0.650; p < 0.001). Conclusions: A higher CHA₂DS₂-VASc score is associated with noncardioembolic mechanisms of stroke and with a higher risk of bleeding. Strategies to treat macro/microangiopathy such as use of statin for plaque stabilization, as well as oral anticoagulants with a lower bleeding risk, are needed in these patients.

Evaluating the Potential Pathology and Short-Term Outcomes of Cryptogenic Stroke Using the Etiological Classification System

“…Moreover, white matter lesions was reported to be associated with the inhibition of short-term recovery from unilateral spatial neglect after stroke 33) . Several lines of emerging evidence reveal the association between small-vessel disease and cardiac pathology: (1) the degree of cerebral white matter disease is significantly high in patients with AF 34) ; (2) the degree of cerebral white matter disease is related to the prevalence of new-onset AF in patients with ESUS 6) ; and (3) CHA2DS2-VASc score is related to leukoaraiosis on the Fazekas scale in patients with stroke with AF 35) . Collectively, our data indicate that the coexistence of cardiac pathology and small-vessel disease in patients with CS might contribute to poor functional outcomes based on the mRS score at hospital discharge.…”

Scoring systems stratifying the risk of bleeding, thromboembolism in patients with atrial fibrillation and haemorhagic shock of the patient with triple therapy

“…Maximálny počet bodov je 9, pričom skóre ≥ 3 indikuje vysoké riziko krvácania a antikoagulačná terapia by sa mala starostlivo zvážiť (15). V porovnaní so skórovacím systémom HEMORR2HAGES a/alebo ATRIA má HAS -BLED skóre lepšiu prediktívnu hodnotu v klinickej praxi.…”