Truly low and high thromboembolic risk - impact of risk scores in real life.
BACKGROUND
Anticoagulation therapy is followed by analysis of factors used in the CHA2DS2-VASc score and assessing the risk of bleeding (HAS-BLED).


OBJECTIVE
The aim of the study was to evaluate in 'real life' risk stratification scores in nonvalvular atrial fibrillation (AF).


METHODS
From 81 consecutive patients who had not yet received anticoagulation, 68 were finally enrolled after exclusion criteria. Patients were analyzed related to risk scores: CHADS2 ≥ 2 (group I) vs. CHADS2 < 2 and CHA2DS2-VASc score ≥ 2 (group II) and gender. Patients at high thromboembolic risk were treated with warfarin, after consideration of the patient's decision.


RESULTS
At high risk of thromboembolic complications were 61 patients (90%). In 26 subjects (43%, 15 women - 57%) indication for anticoagulation was established by CHA2DS2-VASc. When compared to CHADS2 ≥ 2, these patients were younger (72 ±10 years vs. 63 ±10 years, p = 0.0002), less frequently burdened with arterial hypertension (p = 0.03) and had lower risk in HAS-BLED (1.23 ±0.65 vs. 0.81 ±0.49, p = 0.03). Seven patients (10%) did not require anticoagulation (CHA2DS2-VASc = 0). Compared to men, women more often had ischemic stroke (2 vs. 18%, p = 0.03), but less coronary artery disease (58 vs. 25%, p = 0.005). During 18 months on warfarin, bleeding occurred in 9 patients (13%, 6 women). On dual antiplatelet therapy were 11 patients (16%). No thromboembolic complications were recorded.


CONCLUSIONS
CHA2DS2-VASc and HAS-BLED schemata easily identify real low and high thromboembolic risk patients and bleeding risk. It seems that women present higher risk of bleeding, but less frequent use of antiplatelet therapy.
Department of Cardiology, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland.
Tomasz
T
Ciurus
Department of Cardiology, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland.
Sebastian
S
Sobczak
Department of Cardiology, Chair of Cardiology and Cardiac Surgery, Medical University of Lodz, Poland.
Małgorzata
M
Lelonek
CHA2DS2-VASc; CHADS2; HAS-BLED; warfarin