Stroke Risk Factors Beyond the CHA₂DS₂-VASc Score: Can We Improve Our Identification of “High Stroke Risk” Patients With Atrial Fibrillation?

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• 作者：Filip M. Szymanski ; MD^a ; ^{filip.szymanski@wum.edu.pl" class="auth_mail" title="E-mail the corresponding author} ; Gregory Y.H. Lip ; MD^b ; ^c ; Krzysztof J. Filipiak ; MD^a ; Anna E. Platek ; MD^a ; Anna Hrynkiewicz-Szymanska ; MD^d ; Grzegorz Opolski ; MD^a
• 刊名：The American Journal of Cardiology
• 出版年：2015
• 出版时间：1 December 2015
• 年：2015
• 卷：116
• 期：11
• 页码：1781-1788
• 全文大小：376 K

文摘

The prevention of stroke and other thromboembolic events plays a crucial role in the management of patients with atrial fibrillation. Not all patients with atrial fibrillation are equal in terms of thromboembolic risk; therefore, not all will benefit from oral anticoagulation treatment. The general principle is that the expected benefit of anticoagulation in reduction of thromboembolic risk must exceed the expected harm caused by possible bleeding. Some guidelines have focused on a categorical approach to stroke prevention, with a focus on identifying patients at high risk for oral anticoagulation. Various current guidelines recommend assessment of stroke risk using the CHADS₂ or CHA₂DS₂-VASc scores to initially detect patients at low risk who require no antithrombotic therapy. However, the scores do not incorporate all possible risk factors causing a high thromboembolic risk. Factors such as impaired renal function, obstructive sleep apnea, and echocardiographic and biochemical or coagulation parameters can also predict adverse thromboembolic events. The present review aims to describe biomarkers whether blood, urine, imaging (cardiac or cerebral), or clinical that go beyond the CHA₂DS₂-VASc score and potentially aid stroke risk assessment. Although useful in some cases, the presented parameters should be perhaps used to further refine initial identification of patients at low risk, after which effective stroke prevention can be offered to those with ≥1 additional stroke risk factors.