Stroke due to atrial fibrillation in a population‐based stroke registry (Ludwigshafen Stroke Study) CHADS2, CHA2DS2‐VASc score, underuse of oral anticoagulation, and implications for preventive measures
Stroke due to atrial fibrillation in a population‐based stroke registry (Ludwigshafen Stroke Study) CHADS2, CHA2DS2‐VASc score, underuse of oral anticoagulation, and implications for preventive measures
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基于人群的卒中登记中心房颤动引起的卒中（路德维希港卒中研究） CHADS2、CHA2DS2-VASc 评分、口服抗凝药物使用不足以及对预防措施的影响
DOI：
10.1111/j.1468-1331.2012.03804.x
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发表时间：
2012
影响因子：
5.1
通讯作者：
Grau AJ
中科院分区：
文献类型：
--
作者：
Palm F;Kleemann T;Dos Santos M;Urbanek C;Buggle F;Safer A;Hennerici MG;Becher H;Zahn R;Grau AJ
背景和目的房颤（AF）是缺血性脑卒中最重要的病因之一。在以人群为基础的卒中登记中，我们检验了对现行指南的低依从性是房颤相关卒中高发的主要原因的假设。方法：路德维希港卒中研究（LuSSt）是一项前瞻性的基于人群的卒中登记研究，我们分析了2006年和2007年所有因房颤而首次发生缺血性卒中（FEIS）的患者。我们确定房颤是否在卒中前被诊断，并评估卒中前chads2和CHA2DS2‐VASc评分。结果626例FEIS患者中有187例发生心房颤动所致心栓性卒中，其中57例（31%）为新诊断。根据CHADS2评分的回顾性卒中前风险分层显示，34例（18%）患者为低/中危，153例（82%）患者为高危（CHADS2≥2）。应用CHA2DS2‐VASc评分将低/中危患者（CHA2DS2‐VASc评分0-1）的数量减少至5例（2.7%）。在卒中前chads2评分≥2且已知房颤（n= 106）的患者中，38例（36%）患者在入院时接受了维生素K拮抗剂治疗，而只有16例（15%）患者的治疗在治疗范围内。结论：我们的研究有力地支持了高危患者口服抗凝药物使用不足对房颤相关卒中有重要影响的假设。CHA2DS2 - VASc评分似乎是比chaads2评分更有价值的风险分层工具。预防措施应侧重于优化房颤的卒中前检测，并更好地实施现行房颤抗凝治疗指南。
Background and purposeAtrial fibrillation (AF) is amongst the most important etiologies of ischaemic stroke. In a population‐based stroke registry, we tested the hypothesis of low adherence to current guidelines as a main cause of high rates of AF‐associated stroke.MethodsWithin the Ludwigshafen Stroke Study (LuSSt), a prospective ongoing population‐based stroke register, we analyzed all patients with a first‐ever ischaemic stroke (FEIS) owing to AF in 2006 and 2007. We determined whether AF was diagnosed before stroke and assessed pre‐stroke CHADS2and CHA2DS2‐VASc scores.ResultsIn total, 187 of 626 patients with FEIS suffered from cardioembolic stroke owing to AF, which was newly diagnosed in 57 (31%) patients. Retrospective pre‐stroke risk stratification according to CHADS2score indicated low/intermediate risk in 34 patients (18%) and high risk (CHADS2≥ 2) in 153 patients (82%). Application of CHA2DS2‐VASc score reduced number of patients at low/intermediate risk (CHA2DS2‐VASc score 0–1) to five patients (2.7%). In patients with a CHADS2score ≥ 2 and known AF (n= 106) before stroke, 38 (36%) were on treatment with vitamin K antagonists on admission whilst only in 16 patients (15%) treatment was in therapeutic range.ConclusionsOur study strongly supports the hypothesis that underuse of oral anticoagulants in high‐risk patients importantly contributes to AF‐associated stroke. CHA2DS2‐VASc score appears to be a more valuable risk stratification tool than CHADS2score. Preventive measures should focus on optimizing pre‐stroke detection of AF and better implementation of present AF‐guidelines with respect to anticoagulation therapy.
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DOI：
10.1136/bmj.d124
发表时间：
2011-01-31
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Olesen JB;Lip GY;Hansen ML;Hansen PR;Tolstrup JS;Lindhardsen J;Selmer C;Ahlehoff O;Olsen AM;Gislason GH;Torp-Pedersen C
通讯作者：
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影响因子：
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作者：
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通讯作者：
J. D. Fisher
近期全国使用华法林治疗心房颤动的模式。
影响因子：
37.8
作者：
Stafford,RS;Singer,DE
通讯作者：
Singer,DE
DOI：
10.1016/s1062-1458(01)00458-5
发表时间：
2001-11
期刊：
JAMA
影响因子：
--
作者：
B. Gage;A. Waterman;W. Shannon;M. Boechler;M. Rich;M. Radford
通讯作者：
B. Gage;A. Waterman;W. Shannon;M. Boechler;M. Rich;M. Radford
DOI：
10.1001/jama.1994.03510350050036
发表时间：
1994-03-16
影响因子：
120.7
作者：
BENJAMIN, EJ;LEVY, D;WOLF, PA
通讯作者：
WOLF, PA