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Infiltrative Diseases
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Patients with cardiac amyloidosis are at high risk of thromboembolism. El-Am et al. showed that patients with cardiac amyloidosis had a high cancellation rate of direct current cardioversion compared with controls, due to the presence of intracardiac thrombus despite appropriate anticoagulation. Given these findings, a transesophageal echocardiogram is recommended prior to cardioversion despite anticoagulation.25 In a large autopsy study of patients with cardiac amyloidosis, 33% had an intracardiac thrombus identified, with AL amyloidosis being an independent risk factor for thromboembolism. Atrial thrombosis also occurred in normal sinus rhythm, most likely secondary to atrial mechanical dissociation.26 Therefore, the decision for anticoagulation should be based on clinical context instead of just CHA2DS2-VASc score.
Critical Care and Anaesthesia
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rajkumar Rajendram, Alex Joseph, John Davidson, Avinash Gobindram, Prit Anand Singh, Animesh JK Patel
How can the risk of stroke due to POAF be calculated?Assess for risk factors for stroke (i.e. cardiac failure, hypertension, age, gender, diabetes mellitus and previous TIA, stroke or vascular disease). These are incorporated into the CHA2DS2-VASc score. Anticoagulation should be considered if the CHA2DS2-VASc score is 2 or above.
Station 5: Brief Clinical Encounters
Published in Saira Ghafur, Parminder K Judge, Richard Kitchen, Samuel Blows, Fiona Moss, The MRCP PACES Handbook, 2017
Saira Ghafur, Parminder K Judge, Richard Kitchen, Samuel Blows, Fiona Moss
Do you know of a tool one can use to predict stroke risk for patients with AF? The CHA2DS2-VASc score (see below).This score is out of 9 and takes into account other stroke risk factors, including age, diabetes, hypertension and heart failure.The higher the score, the greater the risk of stroke.Dependent on the score, a percentage stroke risk per year for a patient can be given.
Prognostic value of GRACE and CHA2DS2-VASc score among patients with atrial fibrillation undergoing percutaneous coronary intervention
Published in Annals of Medicine, 2021
Tingting Guo, Ziwei Xi, Hong Qiu, Yong Wang, Jianfeng Zheng, Kefei Dou, Bo Xu, Shubin Qiao, Weixian Yang, Runlin Gao
The CHA2DS2-VASc score has been widely used for ischaemic stroke risk stratification in patients with AF [32] as well as patients with CAD and treated with coronary stent implantation [33]. Moreover, in patients without AF, increasing CHA2DS2-VASc score remains associated with an increased risk of MACEs [10,13,34]. A network meta-regression has shown that the CHA2DS2-VASc score was associated with an increased risk of all-cause mortality, both as continuous and as categorical scores [35]. The CHA2DS2-VASc score is comprised of several traditional risk factors that contribute to the poor prognosis of cardiovascular disease. Advanced age, hypertension, stroke/transient ischaemic attack, diabetes, and congestive heart failure were all reported to be associated with adverse outcomes in patients with CAD [7]. Hence, the utility of the CHA2DS2-VASc score in patients with CAD is theoretically reasonable. In addition, the CHA2DS2-VASc score provides physicians a simple, fast, and comprehensive way for risk estimation which can be easily assessed bedside and requires no calculators or computers.
Warfarin therapy in Chinese patients with atrial fibrillation treated with percutaneous coronary intervention: a 5 year follow-up retrospective cohort study
Published in Current Medical Research and Opinion, 2019
Ya Li, Wei Liu, Xiaoli Liu, Hua Shen, Fangjie Hou, Peng Jin, Ziwei Xi, Yujie Zhou
This study suggested that patients with a CHA2DS2-VASc score >4 points had a higher probability of MACCEs and the difference was statistically significant between MACCEs, but the bleeding risk was not increased significantly. The CHA2DS2-VASc score is used to predict stroke events in patients with AF but is now also becoming useful for the prognosis of coronary heart disease without known AF35. Patients with a HAS-BLED score ≥3 had a higher rate of bleeding. The HAS-BLED score is used to assess the bleeding risk of patients with AF. It has also been shown that the HAS-BLED score could predict the risk of bleeding and mortality for patients who underwent PCI independent of the presence of AF36. Therefore, this study shows that, for patients with coronary heart disease complicated by AF after PCI, the bleeding risk should be assessed first by the HAS-BLED or CHA2DS2-VASc score and other assessment tools for risk stratification. For the use of warfarin, further risk assessments for bleeding and ischemia should be performed based on the patient’s characteristics in an effort to develop a more appropriate and individualized treatment plan.
Changes of recommended anticoagulation therapy in patients with atrial fibrillation and high thrombotic risk: long-term follow-up data from two hospital centers
Published in Expert Review of Cardiovascular Therapy, 2021
Irzal Hadžibegović, Ivana Jurin, Tomislav Letilović, Vedran Radonić, Hrvoje Jurin, Štefica Mikšić, Marko Lucijanić
The analysis included a total of 1061 patients with AF that had median age of 71 years (range 30 to 98 years), similar proportion of male [552/1061 (52%)] and female patients [509/1061 (48%)], and received any long-term oral anticoagulation therapy at baseline. Median CHA2DS2-VASC score was 3 points (range 1 to 9), with 965/1061 (91%) of patients being under substantial risk of stroke defined as score ≥2 points. Median CHA2DS2-VASC score was 3 (range 1 to 9) among male patients, and 4 (range 2 to 9) among female patients. Median HAS-BLED score was 2 points (range 0–6), with 297/1061 (28%) of patients being under high risk of major bleeding defined as score ≥3 points.