Predictive Value of the CHA2DS2-VASc Score in Atrial Fibrillation Patients at High Risk for Stroke Despite Oral Anticoagulation

Jover, Eva; Roldán, Vanessa; Gallego, Pilar; Hernández-Romero, Diana; Valdés, Mariano; Vicente, Vicente; Lip, Gregory Y.H.; Marı́n, Francisco

doi:10.1016/j.rec.2012.02.016

Cited by 29 publications

(31 citation statements)

References 34 publications

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“…Our data show that the CHADS 2 and CHA 2 DS 2 -VASc methods have value in stroke-risk evaluation in patients who have a substantial risk of stroke despite optimal anticoagulation. Previously, Jover and co-authors 25 reported that CHA 2 DS 2 -VASc meaningfully predicted cardiovascular events and death among real-world anticoagulated patients with AF.…”

Section: Discussionmentioning

confidence: 99%

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

Zhu¹,

Xiong²,

Hong³

2015

Texas Heart Institute Journal

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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

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Section: Discussionmentioning

confidence: 99%

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

Zhu¹,

Xiong²,

Hong³

2015

Texas Heart Institute Journal

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“…Although the guideline does emphasize on preventing HF by rate and rhythm control, little is known about the risk stratifying model in gauging HF progression in AF [5]. Previous studies showed that CHA 2 DS 2 -VASc score has been reported to be of value in predicting AF-associated mortality, perioperative mortality, and cardiovascular hospitalization [3,4,[18][19][20]. Nevertheless, its role in prediction of adverse outcome other than stroke was not established.…”

Section: Previous Studiesmentioning

confidence: 99%

“…It suggests that studying the contributors of AF-related adverse cardiac events and HF is as paramount as that of stroke. Although CHA 2 DS 2 -VASc score appears to be helpful in this aspect by some studies [3,4], it was not generally applied for this purpose. In addition, current guidance does not stress HF prediction and there lacks a risk scheme to tackle this conundrum [5].…”

Section: Introductionmentioning

confidence: 99%

Echocardiographic parameters versus CHA2DS2-VASc score in prediction of overall cardiac events, heart failure, and stroke in non-valvular atrial fibrillation

Yang

Tsai

2018

Cardiol J.

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“…The CHA 2 DS 2 VASc score is an extremely useful tool to predict thromboembolic events and assess treatment efficacy. 15,16 Objectives To compare the prognostic value of the CHA 2 DS 2 VASc score versus different INR variability methods or its combination to predict mortality in patients receiving warfarin. We hypothesized that the combination of a risk score and a therapeutic evaluation variable has a clinically significant value.…”

mentioning

confidence: 99%

International Normalized Ratio Variability: A Measure of Anticoagulation Quality or a Powerful Mortality Predictor

Vanerio

2015

Journal of Stroke and Cerebrovascular Diseases

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Predictive Value of the CHA2DS2-VASc Score in Atrial Fibrillation Patients at High Risk for Stroke Despite Oral Anticoagulation

Cited by 29 publications

References 34 publications

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

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

Echocardiographic parameters versus CHA2DS2-VASc score in prediction of overall cardiac events, heart failure, and stroke in non-valvular atrial fibrillation

International Normalized Ratio Variability: A Measure of Anticoagulation Quality or a Powerful Mortality Predictor

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