Abstract 197: Do the CHADS2, CHA2 DS2-VASc and HAS-BLED Scores Predict Recurrent Stroke and GI Bleeding in Patients with Acute Ischemic Stroke or TIA and Atrial Fibrillation?
Background: In patients with atrial fibrillation (AF) the CHADS2 and CHA2 DS2-VASc score are used to provide a risk for subsequent stroke and the HAS-BLED score for hemorrhage. These scores were derived from large cohorts of patients with AF, however, only 8 - 25% of the patients had a past history of stroke. We wanted to determine whether these prediction scores had utility in patients with AF who have had a recent stroke or TIA.
Methods: We selected patients with AF and a first stroke or TIA from the 2002-3, 2004-5, 2008-9 and 2010-11 Ontario Stroke Audits (OSA). The OSA includes data from a simple random sample of 15 - 20% of stroke and TIA patients presenting to all Ontario hospitals identified using ICD-10 diagnostic codes I60, I61, I63, I64, H34.1 and G45. Recurrent ischemic stroke, hemorrhagic stroke and major GI hemorrhage were obtained by linking the OSA data to administrative databases for hospital admissions in the subsequent year.
Results: There were 3,960 patients with AF in the OSA who were discharged alive following their first acute stroke or TIA. The median age was 80. At discharge 41% of the patients were prescribed anticoagulants, 24% antiplatelet therapy, 25% both and 9% were prescribed no antithrombotic therapy. The one year readmission rate for stroke was 5.3% (including 0.4% hemorrhagic stroke) and 1.9% for major hemorrhage. Multivariable logistic regression models did not show any significant association between the CHADS2 and CHA2 DS2-VASc scores and the risk of recurrent stroke. The HAS-BLED score failed to predict hemorrhagic stroke or major bleeding and the risk of major bleeding for the entire group at one year was low (1.9%). Patients prescribed anticoagulants at discharge had fewer recurrent strokes (OR 0.55; 95% CI 0.34 - 0.90, p=0.02), a lower one year mortality (OR 0.42; 95% CI 0.31 - 0.56, p <0.001) and the same risk of major bleeding as compared to patients not receiving anticoagulants.
Conclusions: The CHADS2, CHA2 DS2-VASc and HAS-BLED scores did not predict recurrent stroke or hemorrhage in patients following an acute stroke or TIA. Anticoagulation at discharge was associated with a lower risk of recurrent stroke and death without a significant increase in the risk of major hemorrhage.
- © 2012 by American Heart Association, Inc.