Stroke due to atrial fibrillation in a population-based stroke registry (Ludwigshafen Stroke Study) CHADS2, CHA2DS2-VASc score, underuse of oral anticoagulation, and implications for preventive measures
European Journal of Neurology, 07/16/2012
Palm F et al. – The study strongly supports the hypothesis that underuse of oral anticoagulants in high–risk patients importantly contributes to Atrial fibrillation (AF)–associated stroke. CHA2DS2–VASc score appears to be a more valuable risk stratification tool than CHADS2 score. Preventive measures should focus on optimizing pre–stroke detection of AF and better implementation of present AF–guidelines with respect to anticoagulation therapy.Methods
- Within the Ludwigshafen Stroke Study (LuSSt), a prospective ongoing population–based stroke register, the authors analyzed all patients with a first–ever ischaemic stroke (FEIS) owing to AF in 2006 and 2007.
- The authors determined whether AF was diagnosed before stroke and assessed pre–stroke CHADS2 and CHA2DS2–VASc scores.
- In total, 187 of 626 patients with FEIS suffered from cardioembolic stroke owing to AF, which was newly diagnosed in 57 (31%) patients.
- Retrospective pre–stroke risk stratification according to CHADS2 score indicated low/intermediate risk in 34 patients (18%) and high risk (CHADS2 ≥2) in 153 patients (82%).
- Application of CHA2DS2–VASc score reduced number of patients at low/intermediate risk (CHA2DS2–VASc score 0–1) to five patients (2.7%).
- In patients with a CHADS2 score ≥2 and known AF (n = 106) before stroke, 38 (36%) were on treatment with vitamin K antagonists on admission whilst only in 16 patients (15%) treatment was in therapeutic range.