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Updated: Jun 8, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
The CHADS score role in managing anticoagulation after surgical ablation for atrial fibrillation
Niv Ad1, Linda Henry, Karen Schlauch
1Inova Heart and Vascular Institute, Cardiac Surgery Research, Falls Church, Virginia 22042, USA. Niv.ad@inova.org
Insights
The CHADS(2) score may not be suitable for guiding anticoagulation after surgical ablation, as thromboembolic events were infrequent and unrelated to the score. Bleeding events were more common and predicted by CHADS(2).
Area of Science:
- Cardiology
- Medical Devices
- Surgical Procedures
Background:
- Anticoagulation management post-surgical ablation is complex, particularly with restored sinus rhythm and managed left atrial appendage.
- The CHADS(2) score, a tool for assessing thromboembolic stroke risk, is commonly used to guide anticoagulation strategies.
- The score assigns points for congestive heart failure, hypertension, age ≥75, diabetes mellitus, and prior stroke (2 points). A score of ≥2 typically indicates warfarin use.
Purpose of the Study:
- To evaluate the applicability of the CHADS(2) scoring system for determining anticoagulation strategies in patients following surgical ablation.
- To assess the relationship between CHADS(2) scores and the occurrence of thromboembolic events and bleeding in this patient population.
Main Methods:
- A prospective, longitudinal study involving 385 patients undergoing surgical ablation.
- CHADS(2) scores were calculated for all participants.
- Clinical data, including rhythm, anticoagulation, bleeding, and embolic stroke/transient ischemic attack (TIA) events, were collected every 3 months.
- Logistic regression models were employed to identify predictors of events.
Main Results:
- Embolic stroke/TIA occurred in 4 patients (4.2 per 1,000 patient-years), while bleeding events occurred in 69 patients (72.8 per 1,000 patient-years).
- No significant difference in mean CHADS(2) was observed between patients with and without stroke/TIA (0.75 vs. 1.46, p=0.21).
- A significant difference in CHADS(2) was found between patients with major bleeding and those without (2.31 vs. 1.41, p<0.003).
- Logistic regression models did not predict stroke/TIA but were significant predictors of bleeding events.
Conclusions:
- Thromboembolic events after surgical ablation are infrequent and do not appear to be associated with the CHADS(2) score.
- The higher incidence of bleeding events, predicted by the CHADS(2) score, questions its utility in this patient group.
- Further randomized studies are necessary to establish optimal anticoagulation strategies for patients post-surgical ablation.
Background:
Managing anticoagulation after surgical ablation is challenging, especially when sinus rhythm has been restored and the left atrial appendage has been surgically managed. The study purpose was to examine the applicability of the CHADS(2) in determining anticoagulation strategies after surgical ablation. CHADS(2) is a scoring system (0 to 6) used to indicate a patient's risk for a thromboembolic stroke and used for anticoagulation strategies. One point is given for any of the following conditions: C, congestive heart failure; H, hypertension; A, age 75 years old or greater; D, diabetes mellitus; and S, stroke which receives 2 points. A score of 2 or greater is an indication for a patient to be placed on warfarin unless otherwise contraindicated.
Methods:
A prospective, longitudinally designed study where CHADS(2) was calculated for all patients (n = 385). Clinical data on rhythm, anticoagulation medication, bleeding, and embolic stroke-transient ischemic attack (TIA) was obtained every 3 months. Logistic regression models were used to determine significant predictors of either event.
Results:
Of the 385 patients, 17% presented with a history of stroke-TIA. In a mean follow-up of 32.77 ± 16.33 months, embolic stroke-TIA events occurred in 4 patients (4.2 first events per 1,000 patient years) and bleeding events occurred in 69 patients (72.8 first events per 1,000 patient years). There was no significant difference in mean CHADS(2) between the stroke event and nonevent group (0.75 vs 1.46, respectively; p = 0.21), but there was a significant difference in CHADS(2) between the major bleed event group and the nonevent group (2.31 vs 1.41, respectively; p < 0.003). The logistic regression model was not predictive of stroke-TIA, but was significantly predictive of bleeding events (χ(2) = 10.30, p < 0.02).
Conclusions:
The number of thromboembolic events after surgical ablation procedure is low and appears unrelated to the CHADS(2). This, together with the higher rate of bleeding, raises questions regarding the applicability of the CHADS(2) for patients after surgical ablation. A randomized study is required to define the risks and anticoagulation strategies for patients after surgical ablation.
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