title: The impact of CHADS2 score on late stroke after the Cox maze procedure.
abstract: OBJECTIVE
  The Heart Rhythm Society, European Heart Rhythm Association, and European Cardiac Arrhythmia Society jointly recommend indefinite warfarin anticoagulation in patients with CHADS2 (congestive heart failure, hypertension, age, diabetes, and stroke) score of at least 2 who have undergone ablation for atrial fibrillation. This study determined the impact of CHADS2 score on risk of late stroke or transient ischemic attack after the performance of a surgical Cox maze procedure.
  
  
  METHODS
  A retrospective review of 433 patients who underwent a Cox maze procedure at our institution was conducted. Three months after surgery, warfarin was discontinued regardless of CHADS2 score if the patient showed no evidence of atrial fibrillation, was off antiarrhythmic medications, and had no other indication for anticoagulation. A follow-up questionnaire was used to determine whether any neurologic event had occurred since surgery.
  
  
  RESULTS
  Follow-up was obtained for 90% of the study group (389/433) at a mean of 6.6 ± 5.0 years. Among these patients, 32% (125/389) had a CHADS2 score of at least 2, of whom only 40% (51/125) remained on long-term warfarin after surgery. Six patients had late neurologic events (annualized risk of 0.2%). Neither CHADS2 score nor warfarin anticoagulation was significantly associated with the occurrence of late neurologic events. Among the individual CHADS2 criteria, both diabetes mellitus and previous stroke or transient ischemic attack were predictive of late neurologic events.
  
  
  CONCLUSIONS
  The risk of stroke or transient ischemic attack in patients after a surgical Cox maze procedure was low and not associated with CHADS2 score or warfarin use. Given the known risks of warfarin, we recommend discontinuation of anticoagulation 3 months after the procedure if the patient has no evidence of atrial fibrillation, has discontinued antiarrhythmic medications, and is without any other indication for systemic anticoagulation.
authors: Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO, USA.
authors: Mitchell
authors: M
authors: Pet
authors: Jason O
authors: JO
authors: Robertson
authors: Marci
authors: M
authors: Bailey
authors: Tracey J
authors: TJ
authors: Guthrie
authors: Marc R
authors: MR
authors: Moon
authors: Jennifer S
authors: JS
authors: Lawton
authors: Andrew
authors: A
authors: Rinne
authors: Ralph J
authors: RJ
authors: Damiano
authors: Hersh S
authors: HS
authors: Maniar
mesh_terms: D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D048909:Diabetes Complications / Q000150:complications*; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D002546:Ischemic Attack, Transient / Q000209:etiology*; D062072:Patient Acuity; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000209:etiology*; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control*; D013997:Time Factors; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin