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CHADS2 and CHA2DS2-VASc Scores Can Guide the Evaluation of Cryptogenic Ischemic Stroke
Esme Ekizoglu1, Murat Mert Atmaca1, Cagla Cinar-Balcioglu1
1Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
Insights
CHADS₂ and CHA₂DS₂-VASc scores may predict cryptogenic ischemic stroke (CIS) risk in patients on antiplatelet therapy. Higher scores indicate increased risk, suggesting anticoagulation may be beneficial for certain CIS patients.
Area of Science:
- Neurology
- Cardiology
- Stroke Medicine
Background:
- Cryptogenic ischemic strokes (CIS) are commonly treated with antiplatelet therapy.
- Identifying patients at high risk of recurrent stroke despite antiplatelets is crucial for effective prevention.
Purpose of the Study:
- To evaluate the utility of CHADS₂ and CHA₂DS₂-VASc scores in identifying patients with CIS at higher risk of stroke recurrence while on antiplatelet therapy.
- To determine if these scores can guide treatment decisions, potentially indicating a need for anticoagulation.
Main Methods:
- Retrospective analysis of prospectively recorded data from the Istanbul Medical School Stroke Registry (1996-2014).
- Calculation of CHADS₂ and CHA₂DS₂-VASc scores in patients with first-ever CIS, comparing those on antiplatelets (AP group) versus those not (non-AP group).
- Receiver Operating Characteristic (ROC) curve analysis to assess the predictive accuracy of the scores.
Main Results:
- CHADS₂ and CHA₂DS₂-VASc scores were significantly higher in the AP group compared to the non-AP group (P = 0.005 and P = 0.009, respectively).
- ROC analysis indicated predictive value for CHADS₂ score ≥3 (AUC = 0.705) and CHA₂DS₂-VASc score ≥4 (AUC = 0.699).
- Patients in the AP group were older and had a higher prevalence of vascular diseases.
Conclusions:
- CHADS₂ score ≥3 and CHA₂DS₂-VASc score ≥4 may predict ischemic stroke occurrence despite antiplatelet use.
- These scores can help identify CIS patients who might benefit from anticoagulation instead of antiplatelets.
- The findings support using CHADS₂ and CHA₂DS₂-VASc scores for individualized diagnostic and preventive strategies in CIS patients.
Background And Aims:
Cryptogenic ischemic strokes (CIS) are treated with antiplatelets for stroke prevention in routine clinical practice. The objective of this study was to investigate whether the CHADS2 and CHA2DS2-VASc scores may be used to identify the patients with CIS at higher risk of ischemic stroke despite antiplatelet therapy.
Material And Methods:
We calculated CHADS2 and CHA2DS2-VASc scores in patients with first ever CIS; those previously managed with antiplatelets (AP group) and in those without antiplatelets (non-AP group), using the prospectively recorded data of the Istanbul Medical School Stroke Registry from 1996-2014.
Results:
Of the 4466 IS patients, 886 patients with first ever IS had complete data for score calculation. Seventy-five (39 women) of them were diagnosed with CIS. CHADS2 and CHA2DS2-VASc scores were significantly higher in the AP group of 19 patients in comparison to the non-AP group of 56 patients (P = 0.005 and P = 0.009, respectively). ROC curve analyses showed an area under curve (AUC) of 0.705 (CI: 0.57-0.84; P = 0.008) for CHADS2 score ≥3 and AUC of 0.699 (CI: 0.57-0.82; P = 0.01) for CHA2DS2-VASc score ≥4. Vascular diseases were more frequent in the AP group and these patients were older than the patients in the non-AP group (P = 0.025, P = 0.024; respectively).
Conclusions:
CHA2DS2-VASc score ≥ 4 and CHADS2 score ≥3 may be used as a predictor of the occurrence of IS despite regular antiplatelet use and suggest an embolic source which will respond better to anticogulation. Our results support that CHADS2 and CHA2DS2-VASc scores may be useful to identify subgroups among patients with CIS for individualizing diagnostic approach, planning future workup and preventive treatment.
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