title: [Cardioembolic stroke in atrial fibrillation and new anticoagulation criteria: a therapeutic dare].
abstract: BACKGROUND
  Atrial fibrillation (AF) increases five times the risk of stroke. The new risk stratification scheme for establishment of oral anticoagulation CHA2-DS2-VASc performs better in risk stratification of stroke compared to the prior CHADS2 scale.
  
  
  OBJECTIVE
  To evaluate in patients with known AF and cardioembolic stroke, the indication of oral anticoagulation under previous risk embolism according to the CHADS2 scale and new classification CHA2-DS2-VASc, assessing the risk of bleeding with HAS-BLED scale.
  
  
  METHODS
  We included 164 patients with atrial fibrillation and cardioembolic stroke, 87 of them with known AF. It was recorded previous anticoagulant treatment and criteria for prior anticoagulation taking into account CHADS2 scales and CHA2-DS2-VASc, including hemorrhagic risk scale HAS-BLED. In anticoagulated patients INR level was recorded in acute stroke phase.
  
  
  RESULTS
  There were no significant differences in baseline patients characteristics according to previous anticoagulation, except higher percentage of previous stroke in anticoagulated patients (47%). 41.3% were anticoagulated with known AF prior to stroke. From 52 non-anticoagulated patients, 61.5% met criteria for anticoagulation prior to stroke as CHADS2. Using CHA2-DS2-VASc, this percentage increased to 94.2% (p <0.001). 78.8% of non-anticoagulated had a low risk of bleeding according to the scale HAS-BLED. In anticoagulated patients, 67.6% had suboptimal INR at the time of stroke.
  
  
  CONCLUSIONS
  In our study, we found low compliance scales of thromboembolic risk stratification in patients with AF for an optimal treatment strategy. It should be increased its use for primary prevention of stroke and optimization of anti-coagulant therapy in patients with AF.
authors: Hospitales Universitarios Virgen del Rocio, 41013 Sevilla, Espana.
authors: I
authors: I
authors: Perez-Ortega
authors: F
authors: F
authors: Moniche-Alvarez
authors: M D
authors: MD
authors: Jimenez-Hernandez
authors: J R
authors: JR
authors: Gonzalez-Marcos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D019934:International Normalized Ratio; D020766:Intracranial Embolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D019851:Thrombophilia / Q000188:drug therapy* / Q000209:etiology; D016903:Drug Monitoring
chemical_list: D000925:Anticoagulants