title: Comparison of CHADS2 and CHA2DS2-VASC anticoagulation recommendations: evaluation in a cohort of atrial fibrillation ablation patients.
abstract: OBJECTIVE
  Atrial fibrillation (AF) is associated with a high incidence of strokes/thromboembolism. The CHADS2 score assigns points for several clinical variables to identify stroke risk. The CHA2DS2-VASC score uses the same variables but also incorporates age 65 to 74, female gender, and vascular disease in an effort to provide a more refined risk of stroke/thromboembolism. We aimed to examine oral anticoagulation (OAC) recommendations for a cohort of patients undergoing AF ablation depending upon whether thrombo-embolic risk was determined by the CHADS2 or CHA2DS2-VASC score.
  
  
  RESULTS
  For 1411 patients we compared OAC recommendations for each of these risk stratification schemes to one of the three OAC strategies: (i) NO-OAC, (ii) CONSIDER-OAC, and (iii) DEFINITE-OAC. Compared with the CHADS2 score, the CHA2DS2-VASC score reduced NO-OAC from 40.3 to 21.8% and CONSIDER-OAC from 36.6 to 27.9% while increasing DEFINITE-OAC from 23.0 to 50.2% of patients. Age 65 to 74 and female gender accounted for 95.2% and vascular disease for only 4.8% of recommendations for more aggressive OAC using CHA2DS2-VASC. Most vascular disease occurred in patients with higher CHADS2 scores already recommended for DEFINITE-OAC (P < 0.0001). Reclassifying 30 females of age <65 with a CHA2DS2-VASC score of 1 to the NO-OAC group had minimal effect on the overall recommendations.
  
  
  CONCLUSIONS
  Compared with the CHADS2 score, in our AF ablation population, the CHA2DS2-VASC score markedly increases the number of AF patients for whom OAC is recommended. It will be important to determine by randomized trials if this major paradigm shift to greater use of OAC using the CHA2DS2-VASC scoring improves patient outcomes.
authors.affiliation: Silicon Valley Cardiology, 1950 University Avenue, Suite 160, E. Palo Alto, CA 94303, USA.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Winkle
authors.forename: R Hardwin
authors.initials: RH
authors.lastname: Mead
authors.forename: Gregory
authors.initials: G
authors.lastname: Engel
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Kong
authors.forename: Rob A
authors.initials: RA
authors.lastname: Patrawala
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D017115:Catheter Ablation; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Atrial fibrillation; CHA2DS2-VASC score; CHADS2 score
references.citation: JAMA. 1998 Apr 22-29;279(16):1273-7
references.pmid: 9565007
references.citation: Lancet. 1994 Mar 19;343(8899):687-91
references.pmid: 7907677
references.citation: N Engl J Med. 2011 Mar 3;364(9):806-17
references.pmid: 21309657
references.citation: J Thromb Haemost. 2011 Jan;9(1):39-48
references.pmid: 21029359
references.citation: N Engl J Med. 2011 Sep 15;365(11):981-92
references.pmid: 21870978
references.citation: Can J Cardiol. 2012 Mar-Apr;28(2):125-36
references.pmid: 22433576
references.citation: Europace. 2010 Oct;12(10):1360-420
references.pmid: 20876603
references.citation: Chest. 2010 Feb;137(2):263-72
references.pmid: 19762550
references.citation: Circ Cardiovasc Qual Outcomes. 2011 Jan 1;4(1):14-21
references.pmid: 21139092
references.citation: BMJ. 1999 Oct 9;319(7215):958-64
references.pmid: 10514159
references.citation: JAMA. 2003 Aug 27;290(8):1049-56
references.pmid: 12941677
references.citation: Eur Heart J. 2013 Jan;34(3):170-6
references.pmid: 23018151
references.citation: Lancet. 2007 Aug 11;370(9586):493-503
references.pmid: 17693178
references.citation: Eur Heart J. 2012 Jun;33(12):1500-10
references.pmid: 22246443
references.citation: Circulation. 2004 Oct 19;110(16):2287-92
references.pmid: 15477396
references.citation: Lancet. 1989 Jan 28;1(8631):175-9
references.pmid: 2563096
references.citation: Thromb Haemost. 2011 Oct;106(4):739-49
references.pmid: 21789337
references.citation: N Engl J Med. 1990 Mar 22;322(12):863-8
references.pmid: 2407959
references.citation: JAMA. 2002 Nov 20;288(19):2441-8
references.pmid: 12435257
references.citation: Lancet. 1993 Nov 20;342(8882):1255-62
references.pmid: 7901582
references.citation: Stroke. 2010 Dec;41(12):2731-8
references.pmid: 20966417
references.citation: Lancet. 2003 Nov 22;362(9397):1691-8
references.pmid: 14643116
references.citation: BMJ. 2011 Jan 31;342:d124
references.pmid: 21282258
references.citation: Arch Intern Med. 2004 Apr 26;164(8):880-4
references.pmid: 15111374
references.citation: Am J Med. 2012 Aug;125(8):826.e13-23
references.pmid: 22579139
references.citation: Europace. 2012 Oct;14(10):1385-413
references.pmid: 22923145
references.citation: Circulation. 1991 Aug;84(2):527-39
references.pmid: 1860198
references.citation: N Engl J Med. 2009 May 14;360(20):2066-78
references.pmid: 19336502
references.citation: Neurology. 2007 Jan 9;68(2):116-21
references.pmid: 17210891
references.citation: JAMA. 2005 Feb 9;293(6):690-8
references.pmid: 15701910
references.citation: Europace. 2012 Apr;14(4):528-606
references.pmid: 22389422
references.citation: Thromb Haemost. 2012 Jun;107(6):1172-9
references.pmid: 22473219
references.citation: N Engl J Med. 2009 Sep 17;361(12):1139-51
references.pmid: 19717844
references.citation: JAMA. 2001 Jun 13;285(22):2864-70
references.pmid: 11401607