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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

  1. F. Palm1,†,*,
  2. T. Kleemann2,†,
  3. M. Dos Santos1,
  4. C. Urbanek1,
  5. F. Buggle1,
  6. A. Safer3,
  7. M. G. Hennerici4,
  8. H. Becher3,
  9. R. Zahn,
  10. A. J. Grau1

Article first published online: 12 JUL 2012

DOI: 10.1111/j.1468-1331.2012.03804.x

Issue

European Journal of Neurology

European Journal of Neurology

Volume 20, Issue 1, pages 117–123, January 2013

Additional Information

How to Cite

Palm, F., Kleemann, T., Dos Santos, M., Urbanek, C., Buggle, F., Safer, A., Hennerici, M. G., Becher, H., Zahn, R. and Grau, A. J. (2013), 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. European Journal of Neurology, 20: 117–123. doi: 10.1111/j.1468-1331.2012.03804.x

Author Information

  1. 1

    Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany

  2. 2

    Department of Cardiology, Klinikum Ludwigshafen, Ludwigshafen, Germany

  3. 3

    Institute of Public Health, University of Heidelberg, Heidelberg, Germany

  4. 4

    Department of Neurology, Universitätsklinikum Mannheim, University of Heidelberg, Mannheim, Germany

  1. †

    Authors contributed equally.

*Correspondence: F. Palm, Department of Neurology, Städtisches Klinikum Ludwigshafen, Bremserstr. 79, 67063 Ludwigshafen a. Rh., Germany (tel.: ++49 621 5034232; fax: ++49 621 5034233; e-mail: palmf@klilu.de).

  1. †

    Authors contributed equally.

Publication History

  1. Issue published online: 22 DEC 2012
  2. Article first published online: 12 JUL 2012
  3. Manuscript Accepted: 29 MAY 2012
  4. Manuscript Received: 13 APR 2012

Funded by

  • Boehringer Ingelheim
  • Sanofi-Aventis
  • BASF
  • Deutsche Forschungsgemeinschaft
  • GR1102/6-1

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Keywords:

  • atrial fibrillation;
  • cardioembolic stroke;
  • CHA2DS2-VASc score;
  • CHADS2 score;
  • oral anticoagulation

Background and purpose

Atrial 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.

Methods

Within 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 CHADS2 and CHA2DS2-VASc scores.

Results

In 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 CHADS2 score 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 CHADS2 score ≥ 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.

Conclusions

Our 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 CHADS2 score. 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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