atrial fibrillation, stroke, ischemic, cerebral infarction, embolic
DISEASE INTERVENTION COMPARISON RESULTS
JAMA. 2001 Jun 13;285(22):2864-70 Cohorts
IN atrial fibrillation, stroke, ischemic, cerebral infarction, embolic The Use of
CHADS2 score: 1 point each for heart failure, hypertension, age > 75 years, and diabetes mellitus and 2 points for history of stroke or TIA
As Prognostic Item
Is better Than
other scoring systems
To predict risk of stroke: stroke rate increased by 1.5% (95% CI, 1.3-1.7) for each 1-point increase in the CHADS( 2) score from 1.9% (95% CI, 1.2-3.0) for a score of 0.
JAMA. 2002 Nov 20;288(19):2441-8 Meta-Analysis
IN atrial fibrillation, stroke, ischemic, cerebral infarction, embolic The Use of
vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
aspirin
To decrease stroke (of any type): 2.4% per year with warfarin VS. 4.5% with aspirin. But modestly increased major bleeding: 2.2 VS. 1.3% per year. Overall all-cause mortality did not differ
Ann Intern Med. 2007 Jun 19;146(12):857-67 Systematic Review
IN atrial fibrillation, stroke, ischemic, cerebral infarction, embolic The Use of
vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
aspirin
To reduce stroke (any type) rates: by 60% warfarin VS by 20% reduction with aspirin. Increases in major extracranial hemorrhage <= 0.3% per year)
Arch Intern Med. 2005 May 23;165(10):1185-91 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, cerebral infarction, embolic The Use of
vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
aspirin or no treatment
To prevent stroke (69% relative risk decrease with warfarin)
Chest. 2010 Feb;137(2):263-72 Cohorts
IN atrial fibrillation, stroke, ischemic, cerebral infarction, embolic, peripheral embolism The Use of
CHA(2)DS2-VASc score: heart failure, hypertension, age≥75 years, diabetes, previous stroke/TIA, vascular disease, age 65-74 years, sex female. 1 point each, except age>75 & previous stroke, 2 points
As Prognostic Item
Is better Than
CHADS2 and other scores
To predict risk of stroke and peripheral embolism, at 1year, specially in patients at low risk: 0% if 0 points; 0,7% if 1 point; 1.9% if 2 points; 4.7% if 3 points. Less accuracy at scores 4,5 and 6, but fewer patients classified as "intermediate risk"
BMJ. 2011 Jan 31;342:d124. doi: 10.1136/bmj.d124 Cohorts
IN atrial fibrillation, stroke, ischemic, cerebral infarction, embolic, peripheral embolism The Use of
CHA(2)DS2-VASc score: heart failure, hypertension, age≥75 years, diabetes, previous stroke/TIA, vascular disease, age 65-74 years, sex female. 1 point each, except age>75 & previous stroke, 2 points
As Prognostic Item
Is better Than
CHADS2 score
To predict risk of stroke at 1year for patients at low risk: 0.78% if 0 points; 2% if 1 point
J Cardiovasc Electrophysiol. 2011 Jan;22(1):25-30 Cohorts
IN atrial fibrillation, stroke, ischemic, cerebral infarction, embolic, peripheral embolism, elder patients The Use of
CHADS2 and CHA(2)DS2-VASc scores
As Prognostic Item
Is better Than
other available scores
To predict risk of stroke and peripheral embolism: c-statistics 0.717 CHADS2 and 0.724 CHA(2)DS2-VASc. Patients categorized as "moderate-risk" were 5.3% with CHA(2)DS(2)-VASc and 49% with CHADS2
BMJ. 2011 Jun 23;342:d3653. doi: 10.1136/bmj.d3653 Cohorts
IN atrial fibrillation, stroke, ischemic, cerebral infarction, embolic, peripheral embolism, elder patients The Use of
CHADS2 and CHA(2)DS2-VASc scores
As Prognostic Item
Is equal Than
simple pragmatic rule classifying all patients > 75y as high risk
To all scores were similarly performant (c statistics 0.55-0.60). Moreover, they classified most patients as high risk (67% of patients) and the remaining as moderate risk