Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fibrillation

Gage, Brian F.; Waterman, Amy D.; Shannon, W. A.; Boechler, Michael; Rich, Mike; Radford, Martha J.

doi:10.1016/s1062-1458(01)00458-5

Cited by 1,531 publications

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“…The risk of stroke and thromboembolism were assessed using the CHADS2 scheme (an acronym for Congestive heart failure, Hypertension, Age 475 years, Diabetes mellitus, and previous Stroke or transient ischaemic attack). 12 Ischaemic stroke was defined as a neurological deficit of sudden onset that persisted for 424 h, corresponding to a vascular territory in the absence of primary haemorrhage, and was not explained by other causes (trauma, infection, vasculitis). 13 Patients with stroke that occurred during the initial hospitalization or as a complication of procedures were excluded from the analysis.…”

Section: Definitions and Clinical Outcomesmentioning

confidence: 99%

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Siu

Yue

et al. 2010

J Hum Hypertens

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Limited evidence is available on the safety and efficacy of anticoagulants in non-valvular atrial fibrillation (AF) patients with concomitant hypertension. We investigated the safety and efficacy of 476 consecutive anticoagulated Chinese outpatients with non-valvular AF and hypertension. Occurrence of ischaemic stroke and major bleeding, and international normalized ratio (INR) values during these events were recorded. There was no significant difference in anticoagulation control between patients with or without hypertension. INRspecific incidence rates of the events were calculated, which showed no excessive risk for ischaemic stroke (2.5 vs 1.6% per year, P ¼ 0.22) or major bleeding (3.9 vs 3.2% per year, P ¼ 0.29) in non-valvular AF patients with or without hypertension. In multivariate analysis, congestive heart failure, smoking and high CHADS2 score were independent predictors for ischaemic stroke, whereas use of antiplatelet agents was an independent predictor for bleeding. It can be noted that hypertension was not associated with ischaemic stroke or major bleeding. Hypertensive patients who achieved target blood pressure control (o130/80 mm Hg) had a lower ischaemic stroke (0.9 vs 3.1% per year, P ¼ 0.01), but similar bleeding risk compared with those not achieving target blood pressure. Our findings demonstrate the effects of hypertension on the outcomes of warfarin therapy; further investigation is needed to clarify whether more aggressive antihypertensive therapy could result in better outcomes in hypertensive patients with non-valvular AF.

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Section: Definitions and Clinical Outcomesmentioning

confidence: 99%

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Siu

Yue

et al. 2010

J Hum Hypertens

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“…Among these, the CHA 2 DS 2 -VASc score is currently the recommended clinical risk-prediction tool to evaluate the thromboembolism risk in patients with nonvalvular atrial fibrillation (NVAF). 3 The HAS-BLED score is the most widely preferred method for the prediction of bleeding risk. 4 Warfarin, a vitamin K antagonist, is prescribed to many patients to combat the risk of thromboembolism.…”

Section: Introductionmentioning

confidence: 99%

Use of neutrophil‐lymphocyte ratio for risk stratification and relationship with time in therapeutic range in patients with nonvalvular atrial fibrillation: A pilot study

Coşansu

Vatan

Gündüz

et al. 2018

Clinical Cardiology

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BackgroundAtrial fibrillation is one of the most common abnormal heart rhythms. Neutrophil‐lymphocyte ratio (NLR) has emerged as a potential marker for the level of inflammation in cardiac disorders.HypothesisNLR might be associated with thrombosis and bleeding risk scores and might predict cardioembolic risk in nonvalvular atrial fibrillation (NVAF) patients within the therapeutic international normalized ratio (INR).MethodsWe enrolled 272 patients taking warfarin for NVAF and classified them into 2 groups: Group A consisted of patients (n = 132) whose time in therapeutic range (TTR) was ≥65%, and Group B comprised patients (n = 139) whose TTR was <65%.ResultsNLR values were higher in group B than in group A (P < 0.0001). Patients classified as high risk according to CHA2DS2‐VASc score had significantly higher NLR levels (P = 0.002) than those classified as low and intermediate risk. Furthermore, NLR levels were significantly correlated with CHA2DS2‐VASc and HAS‐BLED scores (P < 0.001 and P < 0.0001, respectively). NLR predicted patients within therapeutic INR range (TTR ≥65%) with sensitivity of 81% and specificity of 71% in a receiver operator characteristic curve analysis, using a cutoff value of 2.17. Area under the curve for NLR was 0.81 (P < 0.0001).ConclusionsTo our knowledge, this is the first study showing correlation of NLR with both CHA2DS2‐VASc and HAS‐BLED risk scores. NLR might represent a useful marker to identify patients with high risks of stroke and bleeding and may have predictive value in identifying patients within the therapeutic INR range.

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“…1 More importantly, both hypertension and AF are individually risk factors for stroke, and the risk is even greater if both are present in combination, especially in the presence of diabetes mellitus and/or heart failure. 3 The presence of hypertension, per se, increases the risk of stroke in AF by nearly two-fold. Hypertension may lead to AF via left atrial dilatation, ischaemia and/or increased intra-atrial pressure consequent upon reduced left ventricular compliance, especially in the setting of hypertensive left ventricular hypertrophy (LVH).…”

mentioning

confidence: 99%

“…Hypertension may lead to AF via left atrial dilatation, ischaemia and/or increased intra-atrial pressure consequent upon reduced left ventricular compliance, especially in the setting of hypertensive left ventricular hypertrophy (LVH). 3 Hypertension may also lead to coronary artery disease, and AF is common following myocardial infarction and the frequently associated left ventricular dysfunction. 3 Finally, alcohol can lead to both hypertension and AF.…”

mentioning

confidence: 99%

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Targeting the renin–angiotensin–aldosterone system in atrial fibrillation: from pathophysiology to clinical trials

Boos

Lip

2005

J Hum Hypertens

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Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fibrillation

Cited by 1,531 publications

References 0 publications

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension

Use of neutrophil‐lymphocyte ratio for risk stratification and relationship with time in therapeutic range in patients with nonvalvular atrial fibrillation: A pilot study

Targeting the renin–angiotensin–aldosterone system in atrial fibrillation: from pathophysiology to clinical trials

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