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首页> 外文期刊>European journal of neurology: the official journal of the European Federation of Neurological Societies >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
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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

机译：基于人群的卒中登记中因房颤引起的卒中（路德维希港卒中研究）CHADS2，CHA2DS2-VASc评分，口服抗凝药使用不足以及预防措施的意义

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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.
机译：背景与目的：房颤（AF）是缺血性中风的最重要病因之一。在基于人群的卒中登记中，我们检验了对当前指南依从性低的假设，认为其是房颤相关卒中发生率高的主要原因。方法：在路德维希港中风研究（LuSSt）（一项基于人群的持续中风登记册）中，我们分析了2006年和2007年所有因房颤而患有首次缺血性中风（FEIS）的患者。我们确定是否在房颤之前诊断出房颤并评估了卒中前的CHADS2和CHA2DS2-VASc分数。结果：626例FEIS患者中，有187例因房颤而发生心栓性中风，其中57例（31％）患者被新诊断出。根据CHADS2评分对卒中前危险性进行回顾性分级，发现153例患者（82％）中/低风险为34例（18％），高危（CHADS2≥2）。 CHA2DS2-VASc评分的应用将低/中度风险患者的数量（CHA2DS2-VASc评分0-1）减少到五名患者（2.7％）。在CHADS2评分≥2且卒中前已知房颤（n = 106）的患者中，入院时接受维生素K拮抗剂治疗的患者为38（36％），而只有16名患者（15％）处于治疗范围。结论：我们的研究强烈支持以下假设，即高危患者口服抗凝药的使用不足可导致房颤相关性中风。与CHADS2评分相比，CHA2DS2-VASc评分似乎是更有价值的风险分层工具。预防措施应集中在优化卒中前房颤的检测和更好地实施抗凝治疗方面目前的房颤指南。

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