title: Rate of antithrombotic drug use and clinical outcomes according to CHADS2 scores in patients with an initial cardioembolic stroke who had nonvalvular atrial fibrillation.
abstract: BACKGROUND
  This study investigated the relationship between CHADS2 scores and the rate of antithrombotic drug use and clinical outcomes in patients with an initial cardioembolic stroke who had nonvalvular atrial fibrillation (NVAF).
  
  
  METHODS
  In 234 patients (135 men and 99 women; mean age [± SD] 76 ± 11 years) with initial cardiogenic cerebral embolism with NVAF who were admitted to our hospital between April 2007 and March 2011, the CHADS2 score, use of warfarin, and clinical outcomes were retrospectively investigated.
  
  
  RESULTS
  CHADS2 scores were as follows: 0 points, n = 21 (9%); 1 point, n = 72 (31%); 2 points, n = 92 (39%); 3 points, n = 47 (20%); and 4 points, n = 2 (1%). The overall warfarin use rate was low (14.1%; n = 33), and it was significantly (P = .023) lower for paroxysmal atrial fibrillation (8%) than for chronic atrial fibrillation (18.5%). The clinical outcomes evaluated by the modified Rankin Scale (mRS) score after 3 months were: CHADS2 score 0 points, mRS 0 to 2 (81%) and 3 to 6 (19%); 1 point, mRS 0 to 2 (46%) and 3 to 6 (54%); 2 points, mRS 0 to 2 (46%) and 3 to 6 (54%); and ≥ 3 points, mRS 0 to 2 (29%) and 3 to 6 (71%). The clinical outcome worsened as the CHADS2 score increased (P = .002). Logistic regression analysis revealed that being ≥ 75 years of age and having a high National Institutes of Health Stroke Scale (NIHSS) score on admission were related to a poor outcome (P < .001).
  
  
  CONCLUSIONS
  The overall warfarin use rate was low in initial cardioembolic stroke patients with NVAF. Clinical outcomes deteriorated with increases in the CHADS2 score, age ≥ 75 years, and NIHSS score on admission were related to a poor clinical outcome.
authors: Department of Neurology and Cerebrovascular Medicine, Saitama International Medical Center, Saitama Medical University, Saitama, Japan. ideguchi@saitama-med.ac.jp
authors: Ichiro
authors: I
authors: Deguchi
authors: Hiroshi
authors: H
authors: Ogawa
authors: Yasuko
authors: Y
authors: Ohe
authors: Manabu
authors: M
authors: Nemoto
authors: Norio
authors: N
authors: Tanahashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D017723:Drug Utilization Review / Q000639:trends; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D010343:Patient Admission; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D014859:Warfarin