Use of the CHADS2 risk score to guide antithrombotic treatment in patients with atrial fibrillation - Room for improvement

Swiss Medical Weekly

Volumn 140, Issue 5-6, 2010, Pages 73-77

  Altmann, David R ^a   Kühne, Michael ^a   Sticherling, Christian ^a   Osswald, Stefan ^a   Schaer, Beat A ^a  

^a UNIVERSITY HOSPITAL BASEL   (Switzerland)

Author keywords

Anticoagulation treatment; Antithrombotic therapy; Atrial fibrillation; Stroke

Indexed keywords

ANTICOAGULANT AGENT; ANTIVITAMIN K; FIBRINOLYTIC AGENT;

AGED; ARTICLE; BLEEDING; CHADS2 RISK SCORE; CLINICAL ASSESSMENT; CONTROLLED STUDY; FEMALE; HEART ATRIUM FIBRILLATION; HIGH RISK POPULATION; HOSPITAL ADMISSION; HUMAN; MAJOR CLINICAL STUDY; MALE; NAMED INVENTORIES, QUESTIONNAIRES AND RATING SCALES; OBSERVATIONAL STUDY; PROSPECTIVE STUDY; RISK ASSESSMENT; SCREENING; THROMBOEMBOLISM; METHODOLOGY; RISK FACTOR; TREATMENT WITHDRAWAL;

AGED; AGED, 80 AND OVER; ANTICOAGULANTS; ATRIAL FIBRILLATION; FEMALE; FIBRINOLYTIC AGENTS; HUMANS; MALE; PROSPECTIVE STUDIES; RISK ASSESSMENT; RISK FACTORS; WITHHOLDING TREATMENT;

EID: 76649113385     PISSN: 14247860     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (28)

1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983-8.
2. Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet. 2007;370(9586):493- 503.
3. Connolly S, Pogue J, Hart R, Pfeffer M, Hohnloser S, Chrolavicius S, et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet. 2006;367(9526):1903-12.
4. Hart RG, Pearse LA, Aguillar MT. Meta-Analysis: Antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146:857-67.
5. Zehnder BS, Schaer BA, Jeker U, Cron TA, Osswald S. Atrial fibrillation: estimated excess rate of stroke due to lacking adherence to guidelines. Swiss Med Wkly. 2006;136(47-48):757-60.
6. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285(22):2864-70.
7. Fuster V, Ryden LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, et al. ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology. Eur Heart J. 2001;22(20):1852-923.
8. Nieuwlaat R, Capucci A, Lip GY, Olsson SB, Prins MH, Nieman FH, et al. Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation. Eur Heart J. 2006;27(24):3018-26.
9. Go AS, Hylek EM, Chang Y, Phillips KA, Henault LE, Capra AM, et al. Anticoagulation therapy for stroke prevention in atrial fibrillation: how well do randomized trials translate into clinical practice? JAMA. 2003;290(20):2685-92.
10. Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994;331(13):821-7.
11. Tinetti ME, Baker DI, King M, Gottschalk M, Murphy TE, Acampora D, et al. Effect of dissemination of evidence in reducing injuries from falls. N Engl J Med. 2008;359(3):252-61.
12. Garwood CL, Corbett TL. Use of anticoagulation in elderly patients with atrial fibrillation who are at risk for falls. Ann Pharmacother. 2008;42(4):523-32.
13. Gage BF, Birman-Deych E, Kerzner R, Radford MJ, Nilasena DS, Rich MW. Incidence of intracranial hemorrhage in patients with atrial fibrillation who are prone to fall. Am J Med. 2005;118(6):612-7.
14. Bond AJ, Molnar FJ, Li M, Mackey M, Man-Son-Hing M. The risk of hemorrhagic complications in hospital in-patients who fall while receiving antithrombotic therapy. Thromb J. 2005;3(1):1.
15. Kutner M, Nixon G, Silverstone F. Physicians' attitudes toward oral anticoagulants and antiplatelet agents for stroke prevention in elderly patients with atrial fibrillation. Arch Intern Med. 1991;151(10):1950-3.
16. Antani MR, Beyth RJ, Covinsky KE, Anderson PA, Miller DG, Cebul RD, et al. Failure to prescribe warfarin to patients with nonrheumatic atrial fibrillation. J Gen Intern Med. 1996;11(12):713-20.
17. Chang HJ, Bell JR, Deroo DB, Kirk JW, Wasson JH. Physician variation in anticoagulating patients with atrial fibrillation. Dartmouth Primary Care COOP Project. Arch Intern Med. 1990;150(1):83-6.
18. Bungard TJ, Ghali WA, McAlister FA, Buchan AM, Cave AJ, Hamilton PG, et al. Physicians' perceptions of the benefits and risks of warfarin for patients with nonvalvular atrial fibrillation. CMAJ. 2001;165(3):301-2.
19. Fihn SD, McDonell M, Martin D, Henikoff J, Vermes D, Kent D, et al. Risk factors for complications of chronic anticoagulation. A multicenter study. Warfarin Optimized Outpatient Follow-up Study Group. Ann Intern Med. 1993;118(7):511-20.
20. McMahan DA, Smith DM, Carey MA, Zhou XH. Risk of major hemorrhage for outpatients treated with warfarin. J Gen Intern Med. 1998;13(5):311-6.
21. Shireman TI, Howard PA, Kresowik TF, Ellerbeck EF. Combined anticoagulant-antiplatelet use and major bleeding events in elderly atrial fibrillation patients. Stroke. 2004;35(10): 2362-7.
22. Hylek EM, Evans-Molina C, Shea C, Henault LE, Regan S. Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation. 2007;115(21):2689-96.
23. Wolf AT, Wasan SK, Saltzman JR. Impact of anticoagulation on rebleeding following endoscopic therapy for nonvariceal upper gastrointestinal hemorrhage. Am J Gastroenterol. 2007;102(2):290-6.
24. Oden A, Fahlen M, Hart RG. Optimal INR for prevention of stroke and death in atrial fibrillation: a critical appraisal. Thromb Res. 2006;117(5):493-9.
25. Abdelhafiz AH, Wheeldon NM. Risk factors for bleeding during anticoagulation of atrial fibrillation in older and younger patients in clinical practice. Am J Geriatr Pharmacother. 2008;6(1):1-11.
26. Nieuwlaat R, Dinh T, Olsson SB, Camm AJ, Capucci A, Tieleman RG, et al. Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation? Eur Heart J. 2008;29(7):915-22.
27. Rothschild S, Conen D. Characteristics of bleeding complications in patients with anticoagulant treatment. Swiss Med Wkly. 2008;138(47-48):719-24.
28. Gage BF, Yan Y, Milligan PE, Waterman AD, Culverhouse R, Rich MW, et al. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006;151(3):713-9.