Dorothea Wild, MD, MPH
In older patients who have atrial fibrillation (AF) and use oral anticoagulants, does the CHADS2 score predict intracranial hemorrhage and death?
Subgroup analysis of a randomized controlled trial (Randomized Evaluation of Long-term Anticoagulation Therapy [RE-LYL] trial). ClinicalTrials.gov NCT00262600.
951 clinical centers in 44 countries.
18 112 patients (mean age 71 y, 64% men) who had documented AF; ≥ 1 of previous stroke or transient ischemic attack (TIA), congestive heart failure (CHF), or left ventricular ejection fraction < 40%); and were ≥ 75 years of age or ≥ 65 years of age with diabetes mellitus (DM), hypertension, or coronary artery disease. Patients were receiving dabigatran, 110 mg or 150 mg twice daily, or warfarin. Exclusion criteria included severe heart valve disorder, recent stroke, increased risk for hemorrhage, creatinine clearance < 30 mL/min, and active liver disease.
CHADS2 score (score range 0 to 6): CHF, hypertension, age ≥ 75 years, and DM (1 point each); and history of stroke or TIA (2 points).
Primary efficacy outcome was stroke or systemic embolism; primary safety outcome was major bleeding. Secondary outcomes included intracranial hemorrhage, vascular death, and all-cause mortality.
Patients were classified into 3 groups by CHADS2 score: 0 to 1 (32%), 2 (36%), and 3 to 6 (32%). Higher CHADS2 scores were associated with greater risk for outcomes (Table).
The CHADS2 risk score predicted intracranial hemorrhage and death in older patients who had atrial fibrillation and used oral anticoagulants.
CHADS2 score for predicting clinical outcomes in atrial fibrillation treated with oral anticoagulants*
*CHADS2 score (score range 0 to 6): congestive heart failure, hypertension, age ≥ 75 years, and diabetes mellitus (1 point each); and history of stroke or transient ischemic attack (2 points).
†Based on a Cochran-Armitage test of linear trend.
Wild D. CHADS2 score predicted bleeding and death in atrial fibrillation treated with anticoagulants. Ann Intern Med. ;156:JC4–13. doi: 10.7326/0003-4819-156-8-201204170-02013
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Published: Ann Intern Med. 2012;156(8):JC4-13.
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