Predicción de eventos embólicos en pacientes con fibrilación auricular no valvular: evaluación del score CHADS2 en una población mediterránea

Ortiz, Martín Ruiz; Romo, Elías; Mesa, Dolores; Delgado, Mónica; Anguita, Manuel; Granados, Amador López; Castillo, Juan Carlos; Arizón, José M.; Lezo, José Suárez de

doi:10.1157/13114954

Cited by 25 publications

(9 citation statements)

References 16 publications

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“…Moreover, the cited article did not include peripheral embolisms in the analysis. And, perhaps, true differences in the embolic risk between both populations must also be considered [3]. …”

Section: Discussionmentioning

confidence: 99%

“…This index is obtained by adding 1 point each for the presence of congestive heart failure, hypertension, age ≥75 years, and diabetes mellitus, and 2 points for history of stroke or transient ischemic attack (TIA). Various studies have confirmed its prognostic value [2,3,4], although some authors have pointed out that the CHADS 2 score could be improved [4,5]. …”

Section: Introductionmentioning

confidence: 99%

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Oral Anticoagulation in Nonvalvular Atrial Fibrillation in Clinical Practice: Impact of CHADS<sub>2</sub> Score on Outcome

et al. 2010

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Objectives: CHADS₂ score predicts embolic risk in patients with nonvalvular atrial fibrillation (NVAF), but also bleeding risk in patients receiving oral anticoagulation (OAC). Our objective is to analyze the effectiveness and safety of OAC in patients with NVAF in daily clinical practice, according to embolic risk evaluated by means of CHADS₂ score. Methods: All consecutive outpatients with permanent NVAF seen at 2 cardiology clinics were prospectively followed for embolic events (transient ischemic attack, ischemic stroke, peripheral embolism) and severe bleedings. OAC was prescribed according to the recommendations of scientific associations. CHADS₂ score was obtained for each patient. Results: From February 1, 2000 to July 31, 2003, 796 outpatients fulfilled the inclusion criteria. OAC was prescribed to 564 (71%) patients. After 2.4 ± 1.9 years of follow-up, the embolic event rates (per 100 patient-years) for each stratum of the CHADS₂score for patients with/without OAC were: 1/4.1, p = 0.23 (CHADS₂ = 0); 0.6/7.1, p = 0.0018 (CHADS₂ = 1); 0.5/5.1, p = 0.0014 (CHADS₂ = 2); 2.4/12.5, p = 0.0017 (CHADS₂ = 3) and 2.9/20, p = 0.013 (CHADS₂ ≧4). The severe bleeding rates for the same CHADS₂ score strata were 3/0.8, 0.8/0.7, 1.3/0.7, 0.4/0, and 2.9/5 in patients with/without OAC (n.s.). Conclusion: OAC is effective and safe in daily clinical practice in patients with NVAF and CHADS₂ score ≧1.

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“…Moreover, the cited article did not include peripheral embolisms in the analysis. And, perhaps, true differences in the embolic risk between both populations must also be considered [3]. …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Oral Anticoagulation in Nonvalvular Atrial Fibrillation in Clinical Practice: Impact of CHADS<sub>2</sub> Score on Outcome

et al. 2010

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“…Those patients with a CHADS2 score of 0 or 1 have a low annual risk of stroke (1%), CHADS2 score of 2 identifies patients with moderate risk (annual risk of 2.5%) and patients with a score of 3 or greater are estimated to have a high risk of stroke (annual risk >5%) [7, 8]. …”

Section: Preventionmentioning

confidence: 99%

“…We find another example in the comparative analysis of five of the most recently used risk classification schemes (Atrial Fibrillation Investigators, Stroke Prevention in Atrial Fibrillation, CHADS2, Framingham score and the 7th American College of Chest Physicians Guidelines), which concludes that all of them are comparable, but with some limitations, because there is an enormous variability in assigning the patient to a risk category, and therefore to a specific antithrombotic therapy [8] (fig. 1).…”

Section: Preventionmentioning

confidence: 99%

Cardioembolic Stroke: Call for a Multidisciplinary Approach

Babarro

Rego²,

González-Juanatey³

2009

Cerebrovasc Dis

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Cardioembolic stroke accounts for one third of all ischemic strokes, and atrial fibrillation (AF) is the cardiac source of emboli in 50% of them. However, the absolute risk of stroke associated with AF has enormous variability, and several clinical risk stratification schemes have been proposed. One of the most validated and used in clinical practice is the CHADS2 index, characterized by its simplicity and rapid application. Current recommendations about antithrombotic therapy in AF patients are based on assessment of annual risk of stroke; thus, antiaggregation is indicated in patients with a low risk, and anticoagulation is prescribed when annual risk is greater than 2.5%. Relevant studies comparing rate and rhythm control do not defend achievement and maintenance of sinus rhythm as a routine management of AF patients and demonstrate that rate control is comparable or even better than rhythm control in terms of survival and quality of life. Optimal control of blood pressure is a relevant factor in preventing cardioembolic stroke in AF patients, because hypertension multiplies the risk of stroke by 12. Antihypertensive drugs such as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers proved to reduce AF recurrences, especially in the context of left ventricular dysfunction and ventricular hypertrophy.

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“…1 It is a simple rule that is easy to remember and apply in clinical practice, and it has been validated in several studies. 2,3 This has facilitated widespread adoption of CHADS 2 and support for its use among major scientific societies in Spain and elsewhere. [4][5][6] The current European guidelines have incorporated additional stroke risk factors in the score to improve identification of patients ''at low risk'' (CHA 2 DS 2 -VASc).…”

Section: Introductionmentioning

confidence: 99%

The CHADS2 Score to Predict Stroke Risk in the Absence of Atrial Fibrillation in Hypertensive Patients Aged 65 Years or Older

Morillas

Pallarés

Fácila

et al. 2015

Revista Española de Cardiología (English Edition)

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Predicción de eventos embólicos en pacientes con fibrilación auricular no valvular: evaluación del score CHADS2 en una población mediterránea

Cited by 25 publications

References 16 publications

Oral Anticoagulation in Nonvalvular Atrial Fibrillation in Clinical Practice: Impact of CHADS<sub>2</sub> Score on Outcome

Oral Anticoagulation in Nonvalvular Atrial Fibrillation in Clinical Practice: Impact of CHADS<sub>2</sub> Score on Outcome

Cardioembolic Stroke: Call for a Multidisciplinary Approach

The CHADS2 Score to Predict Stroke Risk in the Absence of Atrial Fibrillation in Hypertensive Patients Aged 65 Years or Older

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