Stroke mechanism in patients with non‐valvular atrial fibrillation according to the CHADS2 and CHA2DS2‐VASc scores

Cha, Myoung-Jin; Kim, Y. D.; Nam, Hyo Suk; Kim, J.; Lee, D. H.; Heo, Ji Hoe

doi:10.1111/j.1468-1331.2011.03547.x

Cited by 44 publications

(33 citation statements)

References 30 publications

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“…Our data are in line with previous studies that found that the risk of cerebral atherosclerosis increases as CHA 2 DS 2 -VASc score increases [34]. Similarly, Kim et al [35] showed that a high CHADS2 score group more frequently had combined extracranial and intracranial stenosis and proximal stenotic lesions of the symptomatic artery.…”

Section: Discussionsupporting

confidence: 82%

Implications of CHA2DS2-VASc Score in Stroke Patients with Atrial Fibrillation: An Analysis of 938 Korean Patients

Hwang¹,

Chung²,

Lee³

et al. 2017

Eur Neurol

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Background and Aims: The aim of this study was to investigate the stroke mechanisms and associated conditions influencing the decision regarding stroke thromboprophylaxis in patients with atrial fibrillation (AF) plus ischemic stroke, according to the CHA₂DS₂-VASc score. Methods: We evaluated 938 consecutive patients with a diagnosis of AF plus transient ischemic attack/ischemic stroke. Based on the CHA₂DS₂-VASc scores, patients were stratified as score 0 or 1 (n = 151), score 2 (n = 146), score 3 (n = 213), score 4 (n = 185), or score ≥5 (n = 243). Results: Patients with a higher CHA₂DS₂-VASc score were more likely to have noncardioembolic stroke mechanism (p = 0.001). Large-artery atherosclerosis causing stenosis >50% was more frequently observed in the high CHA₂DS₂-VASc group (p < 0.001). Coronary artery disease and the use of antiplatelet agents were more prevalent in the higher group (p < 0.001). A high CHA₂DS₂-VASc score was associated with a higher frequency of cerebral microbleeds and a higher Fazekas grade for leukoaraiosis (p < 0.001). The HAS-BLED score was correlated with the CHA₂DS₂-VASc score (γ = 0.650; p < 0.001). Conclusions: A higher CHA₂DS₂-VASc score is associated with noncardioembolic mechanisms of stroke and with a higher risk of bleeding. Strategies to treat macro/microangiopathy such as use of statin for plaque stabilization, as well as oral anticoagulants with a lower bleeding risk, are needed in these patients.

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Section: Discussionsupporting

confidence: 82%

Implications of CHA2DS2-VASc Score in Stroke Patients with Atrial Fibrillation: An Analysis of 938 Korean Patients

Hwang¹,

Chung²,

Lee³

et al. 2017

Eur Neurol

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“…We additionally hypothesized that the stroke etiology was entirely different in the treatment group. For instance, ischemic stroke may be caused by carotid atherothrombosis in the patients with NVAF under dabigatran therapy (16). However, ASCOD subtyping revealed that the potential involvement of etiologies other than cardioembolism was similar in both groups, and thus the stroke severity-reducing effect of dabigatran was not a result of the differences in stroke etiology.…”

Section: Discussionmentioning

confidence: 97%

Clinical Features of Ischemic Stroke during Treatment with Dabigatran: An Association between Decreased Severity and a Favorable Prognosis

et al. 2015

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Objective Anticoagulation therapy with warfarin is associated with a favorable prognosis in ischemic stroke. Dabigatran, a new oral anticoagulant, is widely used to prevent ischemic stroke in non-valvular atrial fibrillation (NVAF) patients. However, its association with decreased severity and a favorable prognosis once ischemic stroke has occurred remains unknown. Methods We retrospectively reviewed all the patients with NVAF-associated ischemic stroke admitted to our hospital from April 2011 to December 2014 and included those who received dabigatran therapy. We assessed whether the patients were under regular use of the drug or discontinuance and classified them into 2 groups, the treatment and discontinuation groups. Clinical data, including the age, sex, ASCOD stroke phenotype, NVAF type, prescribed drug dose, comorbidities, CHADS2 score, renal function, National Institute of Health Stroke Scale (NIHSS) score on admission, modified Rankin scale (mRS) score at discharge, D-dimer, and brain natriuretic peptide, were investigated and compared between the groups. Results Nine patients were under regular dabigatran therapy, and 6 were under discontinuance of the drug. The age, sex, ASCOD stroke phenotype, NVAF type, comorbidities, renal function, and CHADS2 scores did not differ between the 2 groups; however, the NIHSS scores were significantly lower in the treatment group. The mRS scores at discharge were additionally decreased in the treatment group. Moreover, the D-dimer scores were lower in the treatment group, thus suggesting a possible role in the decreased stroke severity. Conclusion Dabigatran may therefore decrease the severity of ischemic stroke, even if ischemic stroke occurs.

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“…Multiple potential mechanisms of thrombosis have been proposed in AF patients which can be associated with, but not necessarily caused by, proximate arrhythmia occurrence. 37,38 In addition, it is clear that our current risk scoring systems also identify patients at risk for stroke independent of the presence of AF. 39 In one study of 860 patients with AF and a history of stroke, 39% had other potential cardiac sources of embolism beyond AF and 27% had a concomitant possible atherothrombotic mechanism of stroke.…”

Section: Is There a Way To Reconcile The Data For And Against An Assomentioning

confidence: 99%

“…The association of these alternative sources of stroke in patients with AF was significantly correlated with increasing CHADS 2 /CHA 2 S 2 -VASc scores. 38 Other 37 Additionally, patients can have nonthromboembolic strokes because of multiple factors, including hypertension or in situ thrombosis, which have no mechanistic relationship with AF. Therefore, it should not come as a surprise that patients with a history of AF can have thromboembolic events without proximate AF episodes.…”

Section: Is There a Way To Reconcile The Data For And Against An Assomentioning

confidence: 99%

Role of Atrial Fibrillation Burden in Assessing Thromboembolic Risk

Zimetbaum

Waks

Ellis

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Stroke mechanism in patients with non‐valvular atrial fibrillation according to the CHADS₂ and CHA₂DS₂‐VASc scores

Abstract: Increased frequency of concomitant PCSE and that of the atherothrombotic mechanism may explain the high risk of stroke in patients with higher CHADS(2) /CHA(2) DS(2) -VASc score.

Cited by 44 publications

References 30 publications

Implications of CHA<sub>2</sub>DS<sub>2</sub>-VASc Score in Stroke Patients with Atrial Fibrillation: An Analysis of 938 Korean Patients

Implications of CHA<sub>2</sub>DS<sub>2</sub>-VASc Score in Stroke Patients with Atrial Fibrillation: An Analysis of 938 Korean Patients

Clinical Features of Ischemic Stroke during Treatment with Dabigatran: An Association between Decreased Severity and a Favorable Prognosis

Role of Atrial Fibrillation Burden in Assessing Thromboembolic Risk

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