title: CHADS2 and CHA2DS2-VASc scores as bleeding risk indices for patients with atrial fibrillation: the Bleeding with Antithrombotic Therapy Study.
abstract: The CHADS2 and CHA2DS2-VASc scores, that is, ischemic stroke risk indices for patients having atrial fibrillation (AF), may also be useful as bleeding risk indices. Japanese patients with AF, who routinely took oral antithrombotic agents were enrolled from a prospective, multicenter study. The CHADS2 and CHA2DS2-VASc scores were assessed based on information at entry. Scores of 0, 1 and ⩾2 were defined as the low, intermediate and high ischemic risk categories, respectively, for each index. Of 1221 patients, 873 took warfarin, 114 took antiplatelet agents and 234 took both. The annual incidence of ischemic stroke was 0.76% in the low-risk category, 1.46% in the intermediate-risk category and 2.90% in the high-risk category by CHADS2 scores, and 1.44, 0.42 and 2.50%, respectively, by CHA2DS2-VASc scores. The annual incidence of major bleeding in each category was 1.52, 2.19 and 2.25% by CHADS2, and 1.44, 1.69 and 2.24% by CHA2DS2-VASc. After multivariate adjustment, the CHADS2 was associated with ischemia (odds ratio 1.76, 95% confidence interval 1.03-3.38 per 1-category increase) and the CHA2DS2-VASc tended to be associated with ischemia (2.18, 0.89-8.43). On the other hand, associations of the indices with bleeding were weak. In conclusion, bleeding risk increased gradually as the CHADS2 and CHA2DS2-VASc scores increased in Japanese antithrombotic users, although the statistical impact was rather weak compared with their predictive power for ischemic stroke.
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.affiliation: Department of Cerebrovascular Medicine, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yasaka
authors.affiliation: Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Uchiyama
authors.affiliation: Department of Cardiology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Iwade
authors.affiliation: Clinical Research Institute, National Hospital Organization Osaka National Hospital, Osaka, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Koretsune
authors.affiliation: Department of Neurology, Research Institute for Brain and Blood Vessels, Akita, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Nagata
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Department of Neurology, Tokyo Metropolitan HMTC Ebara Hospital, Tokyo, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Nagao
authors.affiliation: Department of Neurology, Yokohama City Brain and Stroke Center, Yokohama, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Neurology, National Hospital Organization Saitama Hospital, Saitama, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Gotoh
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Jun C
authors.initials: JC
authors.lastname: Takahashi
authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D002545:Brain Ischemia / Q000209:etiology*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology*
chemical_list: D005343:Fibrinolytic Agents