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

• Verfasst von: Palm, Frederick [VerfasserIn]
• Verfasst von: Kleemann, T. [VerfasserIn]
• Verfasst von: Martins dos Santos, Michael [VerfasserIn]
• Verfasst von: Urbanek, Christian [VerfasserIn]
• Verfasst von: Buggle, F. [VerfasserIn]
• Verfasst von: Safer, Anton [VerfasserIn]
• Verfasst von: Hennerici, Michael G. [VerfasserIn]
• Verfasst von: Becher, Heiko [VerfasserIn]
• Verfasst von: Zahn, R. [VerfasserIn]
• Verfasst von: Grau, Armin J. [VerfasserIn]
• Titel: 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
• Verf.angabe: F. Palm, T. Kleemann, M. Dos Santos, C. Urbanek, F. Buggle, A. Safer, M.G. Hennerici, H. Becher, R. Zahn and A.J. Grau
• Jahr: 2013
• Umfang: 7 S.
• Fussnoten: First published: 12 July 2012 ; Im Titel ist die Ziffer "2" jeweils tiefgestellt ; Gesehen am 16.12.2021
• Titel Quelle: Enthalten in: European journal of neurology
• Ort Quelle: Oxford [u.a.] : Wiley-Blackwell, 1994
• Jahr Quelle: 2013
• Band/Heft Quelle: 20(2013), 1, Seite 117-123
• ISSN Quelle: 1468-1331
• DOI: doi:10.1111/j.1468-1331.2012.03804.x
• Datenträger: Online-Ressource
• Sprache: eng
• Bibliogr. Hinweis: Erscheint auch als : Druck-Ausgabe: Stroke due to atrial fibrillation in a population-based stroke registry (Ludwigshafen Stroke Study) CHADS(2), CHA(2)DS(2)-VASc score, underuse of oral anticoagulation, and implications for preventive measures. - 2013
• Sach-SW: atrial fibrillation
• Sach-SW: cardioembolic stroke
• Sach-SW: CHA2DS2-VASc score
• Sach-SW: CHADS2 score
• Sach-SW: oral anticoagulation
• K10plus-PPN: 1782343857

Abstract

Background and purpose Atrial fibrillation (AF) is amongst the most important etiologies of ischaemic stroke. In a population-based stroke registry, we tested the hypothesis of low adherence to current guidelines as a main cause of high rates of AF-associated stroke. Methods Within the Ludwigshafen Stroke Study (LuSSt), a prospective ongoing population-based stroke register, we analyzed all patients with a first-ever ischaemic stroke (FEIS) owing to AF in 2006 and 2007. We determined whether AF was diagnosed before stroke and assessed pre-stroke CHADS2 and CHA2DS2-VASc scores. Results 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. Conclusions Our study strongly supports the hypothesis that underuse of oral anticoagulants in high-risk patients importantly contributes to 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.