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Prediction of stroke in patients without atrial fibrillation using the CHADS2 and CHA2DS2-VASc scores: a justification for more widespread thromboprophylaxis?
  1. Keitaro Senoo,
  2. Gregory Y H Lip
  1. University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
  1. Correspondence to Professor Gregory Y H Lip, University of Birmingham, Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK; g.y.h.lip{at}bham.ac.uk

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The CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, previous stroke/transient ischaemic attack (TIA) (double)) and more recently, the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years (double score), diabetes mellitus, previous stroke/TIA (double score), vascular disease, age 65–74 years, sex category (female)) scores are validated clinical prediction tools commonly used to estimate the stroke risk in atrial fibrillation (AF) patients. More recently, the focus has been on initially identifying those patients at ‘low risk’ (ie, CHA2DS2-VASc score=0 for men, 1 for women) who do not need any antithrombotic therapy. Subsequent to this step, effective stroke prevention can be offered to those patients with AF with ≥1 stroke risk factors.

The CHADS2 and CHA2DS2-VASc scores represent clusters of common cardiovascular risk factors related to thromboembolism. Perhaps unsurprisingly, both scores have been reported to be associated with the incidence of stroke, thromboemblism and mortality, not only in patients with AF but also in general population or non-AF patient populations.

Mitchell et al1 show that the CHADS2 and CHA2DS2-VASc scores could predict the incidence of stroke/TIA in a population of over 20 000 patients with acute coronary syndrome (ACS) without AF. Both scores had acceptable discrimination performance (CHADS2 and CHA2DS2-VASc scores; …

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