Meta-Analysis of CHADS2 versus CHA2DS2-VASc for Predicting Stroke and Thromboembolism in Atrial Fibrillation Patients Independent of Anticoagulation

Abstract

A trial fibrillation (AF), the cardiac arrhythmia most frequently identified in clinical practice, becomes more prevalent as patients age. This condition is characterized by several devastating sequelae, including stroke and systemic thromboembolism (TE).1,2 Atrial fibrillation is a leading cause of neurologic disability and death depending on the severity of cardioembolic stroke, so oral anticoagulation is crucial for high-risk patients who have AF. Nonetheless, hemorrhagic sequelae of long-term anticoagulation are often seen during stroke prevention in patients who have AF. To date, several risk-scoring systems have shown modest predictive ability for endpoint events and have been well validated in recent studies. Two of the most widely used scores for risk prediction, CHADS 2 and CHA 2 DS 2 -VASc, guide the optimization of therapy in patients who have AF, particularly if those patients are artificially categorized into low-, moderate-, and high-risk groups (Table I).3-6 The classical and revised CHADS 2 score is cumulative on the basis of 6 clinical features: congestive heart failure, hypertension, diabetes mellitus, and age ≥75 years (counted as 1 point each), and a history of stroke or transient ischemic attack (2 points). 4,5 In comparison, the CHA 2 DS 2 -VASc score, proposed as a complement to the CHADS 2 score, ranges from 0 to 9 points; the clinical features are congestive heart failure or left ventricular ejection fraction ≤0.40, hypertension, age 65-74 years, diabetes mellitus, vascular disease, and female sex (1 point each), and age ≥75 years and prior stroke, transient ischemic attack, or thromboembolism (2 points each). 6 In both systems, patient stratification into 3 risk categories-wherein a 0 score is low risk, 1 is intermediate risk, and ≥2 is high risk-has received particular attention in embolic risk evaluation and is widely included in guideline recommendations. 2 The likelihood of an embolic event is closely related to the total points recorded for a given patient, and anticoagulation is advisable for patients with a score of 2 or more points.7 However, it is unclear whether anticoagulation should be recommended for intermediate-risk patients. When comparing

The CHADS2 and CHA2DS2-VASc scores for predicting ischemic stroke among East Asian patients with atrial fibrillation: A systemic review and meta-analysis

“…More recently, the CHA 2 DS 2 -VASc score has been shown to have a better performance, as presented by higher C-statistics in several cohort studies [12,13,16,19,20]. A previous meta-analysis demonstrates an approximately 6-fold increased risk of stroke/TE in AF patients with CHA 2 DS 2 -VASc of ≥2, which was significantly better than the 3-fold increased risk predicted by a CHADS 2 score of ≥ 2 [21]. However, no significant difference in predictive ability between both scores has been found in one Japanese cohort study [14].…”

Asymptomatic Pulmonary Embolism after Ablation

“…AF is the most common arrhythmia, most prevalent in the elderly, and it is definitely associated with increased morbidity and mortality [13]. For the primary and secondary prevention of cerebral embolism, anticoagulation strategies are commonly used [13].…”

“…For the primary and secondary prevention of cerebral embolism, anticoagulation strategies are commonly used [13]. Autopsy observations suggest that right atrial thrombus occurs less frequently than left atrial thrombus, though the right atrial appendix has also been reported as a reservoir for thrombi [14,15].…”

Periprocedural antithrombotic management for lumbar puncture: Association of British Neurologists clinical guideline

“…The BSH encourage all patients to be considered on an individual basis, but advise that bridging therapy with treatment dose low-molecular-weight heparin (LMWH) should be considered in those that the thrombotic risk is especially high (table 1). 28 Since the BRIDGE trial was performed, the CHA 2 DS 2 -VASc score has been validated as a better measure of risk for stroke in non-valvular atrial fibrillation than CHADS 2 , and therefore we would advise that the additional risk factors for thrombosis included in CHA 2 DS 2 -VASc score (prior myocardial infarction, peripheral arterial disease, aortic atheroma, age 65–74 years and female sex) also be considered 298…”