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CHA2DS2-VASc Score

Stefan Reers, Tolga Agdirlioglu, Michael Kellner, Matthias Borowski, Holger Thiele, Johannes Waltenberger, Michael Reppel
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran or rivaroxaban are alternatives to vitamin K antagonists (VKAs) for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) and atrial flutter (AFL). Incidences of risk factors for left atrium (LA) and left atrial appendage (LAA) thrombus formation, such as dense spontaneous echo contrast (SEC), low LAA velocity (LAAV) <20 cm/s under treatment with dabigatran and rivaroxaban in comparison with VKAs are unknown...
October 21, 2016: European Journal of Medical Research
Yu-Yang Chen, Qi Liu, Li Liu, Xiao-Rong Shu, Zi-Zhuo Su, Hai-Feng Zhang, Ru-Qiong Nie, Jing-Feng Wang, Shuang-Lun Xie
BACKGROUND: Metabolic syndrome (MS) is a risk factor for stroke and thromboembolism event. Left atrial or LA appendage (LA/LAA) thrombus is a surrogate of potential stroke. The relationship between MS and atrial thrombus remains unclear. In this study, we sought to investigate the effect of MS on risk stratification of LA/LAA thrombus formation in patients with nonvalvular atrial fibrillation (NVAF). METHODS: This cross-sectional study enrolled 294 consecutive NVAF patients without prior anticoagulant and lipid-lowering therapies...
2016: Chinese Medical Journal
Laila Staerk, Emil Loldrup Fosbøl, Gregory Y H Lip, Morten Lamberts, Anders Nissen Bonde, Christian Torp-Pedersen, Brice Ozenne, Thomas Alexander Gerds, Gunnar Hilmar Gislason, Jonas Bjerring Olesen
BACKGROUND: Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) are widely used as stroke prophylaxis in non-valvular atrial fibrillation (AF), but comparative data are sparse. PURPOSE: To compare dabigatran, rivaroxaban, and apixaban vs. VKA and the risk of stroke/thromboembolism (TE) and intracranial bleeding in AF. METHODS: Using Danish nationwide registries (2011-15), anticoagulant-naïve AF patients were identified when initiating VKA or an NOAC...
October 14, 2016: European Heart Journal
Kuniko Yoshida, Masaru Obokata, Koji Kurosawa, Hidemi Sorimachi, Masahiko Kurabayashi, Kazuaki Negishi
BACKGROUND: Embolic stroke in atrial fibrillation is more prevalent in women than in men, yet the basis for this difference remains unclear. This study seeks to elucidate whether there are any sex differences in the relationships between stroke risk (CHADS2 score, CHA2DS2-VASc score without a sex category, and estimated stroke rate) and left atrial (LA) anatomy or mechanics in patients with atrial fibrillation. METHODS AND RESULTS: LA emptying fraction and global peak atrial longitudinal strain were assessed in 414 subjects with paroxysmal or persistent atrial fibrillation (156 women and 258 men)...
October 2016: Circulation. Cardiovascular Imaging
Özcan Başaran, Osman Beton, Volkan Doğan, Mehmet Tekinalp, Ahmet Çağrı Aykan, Ezgi Kalaycıoğlu, İsmail Bolat, Onur Taşar, Özgen Şafak, Macit Kalçık, Mehmet Yaman, İbrahim Altun, Mustafa Özcan Soylu, Cevat Kırma, Murat Biteker
OBJECTIVE: Data regarding stroke prevention strategies in non-valvular atrial fibrillation (NVAF) are limited to vitamin K antagonists (VKAs). This study aimed to evaluate real-life stroke prevention strategies for NVAF patients in the era of non-VKA oral anticoagulants (NOACs). METHODS: We established a cross-sectional, multicenter, nationwide registry of NVAF patients. All consecutive atrial fibrillation (AF) patients and without mechanical heart valves or rheumatic mitral stenosis (but including those with any degree of mitral regurgitation) were enrolled in the ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies (RAMSES Study; ClinicalTrials...
October 2016: Anatolian Journal of Cardiology
Francesco Pelliccia, Salvatore Rosanio, Giuseppe Marazzi, Sara Poggi, Alessandra Tanzilli, Cesare Greco, Carlo Gaudio, Giuseppe Rosano
The high risk of both stroke and major bleeding in atrial fibrillation (AF) patients with chronic kidney disease (CKD) defines an important population for whom the assessment of the balance between the risk of ischemic stroke and of bleeding is essential. The use of novel oral anticoagulants (NOACs) may be a viable option in this population due to their greater net clinical benefit than warfarin, as demonstrated by the results of the clinical phase III trials. NOACs have been found to have a greater net clinical benefit than warfarin in patients at high risk of either stroke (CHADS2≥1 or CHA2DS2-VASc score≥2) or bleeding (HAS-BLED≥3)...
October 1, 2016: International Journal of Cardiology
Federico Guerra, Lorena Scappini, Alessandro Maolo, Gianluca Campo, Rita Pavasini, Matilda Shkoza, Alessandro Capucci
BACKGROUND: Stroke is a rare but serious complication of acute coronary syndrome. At present, no specific score exists to identify patients at higher risk. The aim of the present study is to test whether each clinical variable included in the CHA2DS2-VASc score retains its predictive value in patients with recent acute coronary syndrome, irrespective of atrial fibrillation. METHODS: The meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines...
October 5, 2016: European Heart Journal. Acute Cardiovascular Care
Zach Rozenbaum, Avishay Elis, Mony Shuvy, Dina Vorobeichik, Nir Shlomo, Meital Shlezinger, Ilan Goldenberg, Oded Kimhi, David Pereg
BACKGROUND: The CHA2DS2-VASc score has been recommended for the assessment of thromboembolic risk in patients with atrial fibrillation. HYPOTHESIS: The CHA2DS2-VASc score may be associated with adverse outcomes in patients with ACS. METHODS: Included were patients with ACS enrolled in the Acute Coronary Syndrome Israeli biennial Surveys (ACSIS) during 2000-2013. Patients were divided into 4 groups according to their CHA2DS2-VASc score (0 or 1, 2 or 3, 4 or 5, and >5)...
October 1, 2016: European Journal of Internal Medicine
Christian T Ruff, Robert P Giugliano, Eugene Braunwald, Sabina A Murphy, Karen Brown, Petr Jarolim, Michele Mercuri, Elliott M Antman, David A Morrow
Importance: Treatment decisions in atrial fibrillation (AF) are based on clinical assessment of risk. The CHA2DS2-VASc (cardiac failure or dysfunction, hypertension, age 65-74 [1 point] or ≥75 years [2 points], diabetes mellitus, and stroke, transient ischemic attack or thromboembolism [2 points]-vascular disease, and sex category [female]) risk score is pragmatic and widely used but has only moderate discrimination. Objective: To develop and test a cardiovascular biomarker score for indication of risk in patients with AF...
October 5, 2016: JAMA Cardiology
Yuan Hung, Tze-Fan Chao, Chia-Jen Liu, Ta-Chuan Tuan, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Jo-Nan Liao, Fa-Po Chung, Wen-Yu Lin, Wei-Shiang Lin, Shu-Meng Cheng, Tzeng-Ji Chen, Gregory Y H Lip, Shih-Ann Chen
BACKGROUND: Recent studies demonstrated that oral anticoagulants (OACs) should be considered for patients with atrial fibrillation and 1 risk factor in addition to sex. Because age is an important determinant of ischemic stroke, the strategy for stroke prevention may be different for these patients in different age strata. The aim of this study was to investigate whether OACs should be considered for patients aged 20 to 49 years with atrial fibrillation and a CHA2DS2-VASc score of 1 (men) or 2 (women)...
October 4, 2016: Journal of the American Heart Association
Timothy R Betts, Milena Leo, Sandeep Panikker, Prapa Kanagaratnam, Michael Koa-Wing, David Wyn Davies, David Hildick-Smith, Dylan G Wynne, Oliver Ormerod, Oliver R Segal, Anthony W Chow, Derick Todd, Sandra Cabrera Gomez, Graeme J Kirkwood, David Fox, Chris Pepper, John Foran, Tom Wong
OBJECTIVES: This study aimed at assessing the feasibility and long-term efficacy of left atrial appendage occlusion (LAAO) in a "real world" setting. BACKGROUND: Although LAAO has recently emerged as an alternative to oral anticoagulants in patients with atrial fibrillation for the prevention of thromboembolic stroke, "real world" data about the procedure with different devices are lacking. METHODS: Eight centers in the United Kingdom contributed to a retrospective registry for LAAO procedures undertaken between July 2009 and November 2014...
September 21, 2016: Catheterization and Cardiovascular Interventions
Joan Martí-Fàbregas, Sebastián Figueroa, Eva Martínez-Lizana, Irati Zubizarreta, David Carrera, Alejandro Martínez-Domeño, Luis Prats-Sánchez, Pol Camps-Renom, Elena Jiménez-Xarrié, Raquel Delgado-Mederos
Chronic hypoperfusion may hinder the washout of emboli coming from the heart and facilitate the formation of intra-cavitary thrombi. We investigated whether a decreased total cerebral blood flow (tCBF) resulted in recurrence of stroke and other vascular events in consecutive patients with cardioembolic stroke. We excluded patients with extra-cranial carotid or vertebral stenosis. The recorded tCBF was the sum of blood flow in both the carotid and vertebral extra-cranial arteries as measured with ultrasonography...
September 17, 2016: Ultrasound in Medicine & Biology
A John Camm, Gabriele Accetta, Giuseppe Ambrosio, Dan Atar, Jean-Pierre Bassand, Eivind Berge, Frank Cools, David A Fitzmaurice, Samuel Z Goldhaber, Shinya Goto, Sylvia Haas, Gloria Kayani, Yukihiro Koretsune, Lorenzo G Mantovani, Frank Misselwitz, Seil Oh, Alexander G G Turpie, Freek W A Verheugt, Ajay K Kakkar
OBJECTIVE: We studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and ≥1 additional stroke risk factor between 2010 and 2015. METHODS: 39 670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF): cohort C1 (2010-2011), n=5500; C2 (2011-2013), n=11 662; C3 (2013-2014), n=11 462; C4 (2014-2015), n=11 046...
September 19, 2016: Heart: Official Journal of the British Cardiac Society
Jing Zhang, Xi-Ai Yang, Yi Zhang, Jing-Ya Wei, Feng Yang, Hua Gao, Wen-Wen Jiao, Xiao-Long Sun, Qiong Gao, Wen Jiang
BACKGROUND: Anticoagulation therapy has been recommended by major guidelines to reduce the risk of recurrent stroke in patients with atrial fibrillation-associated ischemic stroke (AFAIS). However, in real-world clinical practice, oral anticoagulants with either vitamin K antagonists or nonvitamin K antagonists are often underused for these patients. Here, we sought to investigate the current status of oral anticoagulant use in patients with AFAIS in northwestern China. METHODS: We reviewed medical records of consecutive patients with AFAIS discharged from 14 hospitals in northwestern China between January 2012 and May 2015...
September 16, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Cecilia Gutierrez, Daniel G Blanchard
Atrial fibrillation is a supraventricular arrhythmia that adversely affects cardiac function and increases the risk of stroke. It is the most common arrhythmia and a major source of morbidity and mortality; its prevalence increases with age. Pulse rate is sensitive, but not specific, for diagnosis, and suspected atrial fibrillation should be confirmed with 12-lead electrocardiography. Because normal electrocardiographic findings do not rule out atrial fibrillation, home monitoring is recommended if there is clinical suspicion of arrhythmia despite normal test results...
September 15, 2016: American Family Physician
Craig I Coleman, Matthias Antz, Kevin Bowrin, Thomas Evers, Edgar P Simard, Hendrik Bonnemeier, Riccardo Cappato
BACKGROUND: Little data exists regarding the effectiveness and safety of rivaroxaban or apixaban versus warfarin in nonvalvular atrial fibrillation (NVAF) patients treated outside of clinical trials. METHODS: This was a retrospective study using MarketScan claims from January 2012 to October 2014. We included adults, newly initiated on rivaroxaban, apixaban or warfarin, with a baseline CHA2DS2-VASc score ≥2, ≥2 diagnosis codes for NVAF and ≥180 days of continuous medical and prescription benefits...
September 20, 2016: Current Medical Research and Opinion
Qian Wang, Shi-Li Jiang, Xu Liu, Yi-Qing Yang
Objective Little is known about the outcome of repeat catheter ablation of long-standing persistent atrial fibrillation (AF) in patients with a total AF duration of more than 2 years. The main objective of this study was to explore the results and factors affecting the clinical success rate of these repeat procedures. Methods We enrolled 99 patients with a total AF duration of more than 2 years and recurrent atrial arrhythmias after the initial catheter ablation of long-standing persistent AF. The enrolled patients were divided into two groups named the AF-recurrence group (50 patients) and the atrial tachycardia (AT)-recurrence group (49 patients) and all underwent a strict follow-up...
2016: Internal Medicine
Tze-Fan Chao, Gregory Y H Lip, Chia-Jen Liu, Ta-Chuan Tuan, Su-Jung Chen, Kang-Ling Wang, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Tzeng-Ji Chen, Chern-En Chiang, Shih-Ann Chen
BACKGROUND AND PURPOSE: The age threshold for an increased stroke risk for patients with atrial fibrillation may be different for Asians and non-Asians. We hypothesized that a modified CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female) scheme, mCHA2DS2-VASc, which assigned one point for patients aged 50 to 74 years, may perform better than CHA2DS2-VASc score for stroke risk stratification in Asians...
October 2016: Stroke; a Journal of Cerebral Circulation
Sweta Tiwari, Maja-Lisa Løchen, Bjarne K Jacobsen, Laila A Hopstock, Audhild Nyrnes, Inger Njølstad, Ellisiv B Mathiesen, Henrik Schirmer
OBJECTIVE: CHA2DS2-VASc score, left atrial (LA) size and atrial fibrillation (AF) have individually been associated with stroke risk. Our aim was to investigate the predictive ability of combinations of these factors for the odds of incident stroke in a population-based cohort study. METHODS: We followed 2844 participants from the Tromsø Study from 1994 to 2012. Information on LA size and CHA2DS2-VASc score (age, sex, congestive heart failure, hypertension, vascular disease, stroke and diabetes) were obtained at baseline...
2016: Open Heart
Eitaro Kodani, Hirotsugu Atarashi, Hiroshi Inoue, Ken Okumura, Takeshi Yamashita, Toshiaki Otsuka, Hirofumi Tomita, Hideki Origasa
BACKGROUND: To clarify the influence of hypertension and blood pressure (BP) control on thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J-RHYTHM Registry was performed. METHODS AND RESULTS: A consecutive series of outpatients with atrial fibrillation was enrolled from 158 institutions. Of 7937 patients, 7406 with nonvalvular atrial fibrillation (70.8% men, 69.8±10.0 years) were followed for 2 years or until an event occurred...
September 2016: Journal of the American Heart Association
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