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
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...
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| Main Authors: | , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2013
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| In: |
European journal of neurology
Year: 2013, Volume: 20, Issue: 1, Pages: 117-123 |
| ISSN: | 1468-1331 |
| DOI: | 10.1111/j.1468-1331.2012.03804.x |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1111/j.1468-1331.2012.03804.x Verlag, lizenzpflichtig, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1468-1331.2012.03804.x 
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| Author Notes: | F. Palm, T. Kleemann, M. Dos Santos, C. Urbanek, F. Buggle, A. Safer, M.G. Hennerici, H. Becher, R. Zahn and A.J. Grau |
| Summary: | 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. |
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| Item Description: | First published: 12 July 2012 Im Titel ist die Ziffer "2" jeweils tiefgestellt Gesehen am 16.12.2021 |
| Physical Description: | Online Resource |
| ISSN: | 1468-1331 |
| DOI: | 10.1111/j.1468-1331.2012.03804.x |