Abstract
We investigated a multicenter registry to identify estimated event rates according to CHA2DS2-VASc scores in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). The additional effectiveness of antiplatelets (APs) plus oral anticoagulants (OACs) compared with OACs alone considering the CHA2DS2-VASc scores was also explored. This study retrospectively analyzed a multicenter stroke registry between Jan 2011 and Nov 2017, identifying patients with acute ischemic stroke with AF. The primary outcome event was a composite of recurrent stroke, myocardial infarction, and all-cause mortality within 1 year. A total of 7395 patients (age, 73 ± 10 years; men, 54.2%) were analyzed. The primary outcome events at one year ranged from 5.99% (95% CI 3.21–8.77) for a CHA2DS2-VASc score of 0 points to 30.45% (95% CI 24.93–35.97) for 7 or more points. After adjustments for covariates, 1-point increases in the CHA2DS2-VASc score consistently increased the risk of primary outcome events (aHR 1.10 [1.06–1.15]) at 1-year. Among OAC-treated patients at discharge (n = 5500), those treated with OAC + AP (vs. OAC alone) were more likely to experience vascular events, though among patients with a CHA2DS2-VASc score of 5 or higher, the risk of primary outcome in the OAC + AP group was comparable to that in the OAC alone group (Pint = 0.01). Our study found that there were significant associations of increasing CHA2DS2-VASc scores with the increasing risk of vascular events at 1-year in AIS with AF. Further study would be warranted.
Highlights
Current practice guidelines recommend risk stratification with the CHA2DS2-VASc score to identify appropriate candidates for anticoagulation to prevent thromboembolic stroke in patients with atrial fibrillation (AF)[1]
The inclusion criteria were as follows: 1) patients with acute ischemic stroke (AIS) or neuroimaging-positive transient ischemic attack (TIA) hospitalized within 48 h of onset, 2) those with known AF or whose AF was diagnosed during hospitalization, and 3) those with mild-to-moderate stroke (National Institutes of Health Stroke Scale (NIHSS) scores ≤ 15)
Our results provide important information on the estimated risk of vascular events according to the CHA2DS2-VASc score in real-world cohorts of AIS patients with AF considering oral anticoagulants (OACs) treatment
Summary
Current practice guidelines recommend risk stratification with the CHA2DS2-VASc score to identify appropriate candidates for anticoagulation to prevent thromboembolic stroke in patients with atrial fibrillation (AF)[1]. After acute ischemic stroke (AIS) in patients with AF, anticoagulation would be strongly indicated as stroke would score at least 2 on the CHA2DS2-VASc4. For patients with AIS and AF, the CHA2DS2-VASc scores might be useful for estimation of the vascular event risks, not identification of appropriate candidates for OAC. Given the common coexistence of AF and atherothrombotic risks, it remains to be investigated whether OAC-only treatment could be optimal management in stroke patients with AF, especially those with high CHA2DS2-VASc scores. We investigated a multicenter registry to identify the estimated vascular event rates according to the CHA2DS2-VASc scores in patients with AIS and AF and the additional effectiveness of combined treatment with AP and OAC therapy compared with OAC alone, considering the CHA2DS2-VASc scores
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