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Does the CHA2DS2-VASc scale sufficiently predict the risk of left atrial appendage thrombus in patients with diagnosed atrial fibrillation treated with non-vitamin K oral anticoagulants?
Medicine (Baltimore). 2020 Jun 19; 99(25):e20570.M

Abstract

The CHA2DS2-VASc scale does not include potential risk factors for left atrial appendage thrombus (LAAT) formation such as a form of atrial fibrillation (AF) and impaired kidney function. The real risk of thromboembolic complications in AF patients is still unclear as well as an optimal anticoagulant treatment in males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2.The aim of this study was to compare the predictive value of the CHA2DS2-VASc scale and other scales to estimate the risk of LAAT formation in AF patients treated with non-vitamin K oral anticoagulants (NOACs) and to assess the prevalence of thrombi in patients at intermediate risk of stroke.The observational study included consecutive patients with a diagnosis of non-valvular AF treated with NOACs, admitted to 3 high-reference institutions between 2013 and 2018. All individuals underwent transoesophageal echocardiography before cardioversion or ablation.Out of 1163 enrolled AF patients (62.1% male, mean age 62 years) the LAAT had been detected in 50 individuals (4.3%). Among patients with LAAT, 1 patient (2.0%) was classified as a low-risk category, 9 (18.0%) were at intermediate-risk, and 40 (80.0%) were at high risk of thromboembolic complications according to CHA2DS2-VASc scale. All patients were treated with NOACs: 51.0% rivaroxaban, 47.1% dabigatran, and 1.9% apixaban.Patients at intermediate stroke-risk with detected LAAT had higher R2CHADS2 score (2.1 ± 1.2 vs 1.2 ± 0.8, P = .007), higher CHA2DS2-VASc-RAF score (6.4 ± 4.4 vs 3.7 ± 2.6, P = .027) and more often had an estimated glomerular filtration rate below 56 mL/min/1.73 m (44.4% vs 13.2%, P = .026) compared to patients without LAAT. The receiver operating characteristics revealed that the CHA2DS2-VASc-RAF scale had better predictive ability to distinguish between patients with and without LAAT in the study group than CHA2DS2-VASc (P = .0006), CHADS2 (P = .0006) and R2CHADS2 scale (P = .0140).The CHA2DS2-VASc scale should be supplemented with an assessment of renal function and form of AF to improve stroke risk estimation. The application of additional scales to estimate the risk of LAAT might be especially useful among males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2.

Authors+Show Affiliations

Collegium Medicum, the Jan Kochanowski University.Collegium Medicum, the Jan Kochanowski University. 1 Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre.Faculty of Natural Sciences, the Jan Kochanowski University, Kielce.1 Chair and Department of Cardiology, Medical University of Warsaw.Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.Collegium Medicum, the Jan Kochanowski University. 1 Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre.1 Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre.1 Chair and Department of Cardiology, Medical University of Warsaw.1 Chair and Department of Cardiology, Medical University of Warsaw.Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.1 Chair and Department of Cardiology, Medical University of Warsaw.1 Chair and Department of Cardiology, Medical University of Warsaw.Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.1 Chair and Department of Cardiology, Medical University of Warsaw.1 Chair and Department of Cardiology, Medical University of Warsaw.Collegium Medicum, the Jan Kochanowski University. 1 Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

32569181

Citation

Michalska, Anna, et al. "Does the CHA2DS2-VASc Scale Sufficiently Predict the Risk of Left Atrial Appendage Thrombus in Patients With Diagnosed Atrial Fibrillation Treated With Non-vitamin K Oral Anticoagulants?" Medicine, vol. 99, no. 25, 2020, pp. e20570.
Michalska A, Gorczyca I, Chrapek M, et al. Does the CHA2DS2-VASc scale sufficiently predict the risk of left atrial appendage thrombus in patients with diagnosed atrial fibrillation treated with non-vitamin K oral anticoagulants? Medicine (Baltimore). 2020;99(25):e20570.
Michalska, A., Gorczyca, I., Chrapek, M., Kapłon-Cieślicka, A., Uziębło-Życzkowska, B., Starzyk, K., Jelonek, O., Budnik, M., Gawałko, M., Krzesiński, P., Jurek, A., Scisło, P., Kochanowski, J., Kiliszek, M., Gielerak, G., Filipiak, K. J., Opolski, G., & Wożakowska-Kapłon, B. (2020). Does the CHA2DS2-VASc scale sufficiently predict the risk of left atrial appendage thrombus in patients with diagnosed atrial fibrillation treated with non-vitamin K oral anticoagulants? Medicine, 99(25), e20570. https://doi.org/10.1097/MD.0000000000020570
Michalska A, et al. Does the CHA2DS2-VASc Scale Sufficiently Predict the Risk of Left Atrial Appendage Thrombus in Patients With Diagnosed Atrial Fibrillation Treated With Non-vitamin K Oral Anticoagulants. Medicine (Baltimore). 2020 Jun 19;99(25):e20570. PubMed PMID: 32569181.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does the CHA2DS2-VASc scale sufficiently predict the risk of left atrial appendage thrombus in patients with diagnosed atrial fibrillation treated with non-vitamin K oral anticoagulants? AU - Michalska,Anna, AU - Gorczyca,Iwona, AU - Chrapek,Magdalena, AU - Kapłon-Cieślicka,Agnieszka, AU - Uziębło-Życzkowska,Beata, AU - Starzyk,Katarzyna, AU - Jelonek,Olga, AU - Budnik,Monika, AU - Gawałko,Monika, AU - Krzesiński,Paweł, AU - Jurek,Agnieszka, AU - Scisło,Piotr, AU - Kochanowski,Janusz, AU - Kiliszek,Marek, AU - Gielerak,Grzegorz, AU - Filipiak,Krzysztof J, AU - Opolski,Grzegorz, AU - Wożakowska-Kapłon,Beata, PY - 2020/6/23/entrez PY - 2020/6/23/pubmed PY - 2020/7/3/medline SP - e20570 EP - e20570 JF - Medicine JO - Medicine (Baltimore) VL - 99 IS - 25 N2 - The CHA2DS2-VASc scale does not include potential risk factors for left atrial appendage thrombus (LAAT) formation such as a form of atrial fibrillation (AF) and impaired kidney function. The real risk of thromboembolic complications in AF patients is still unclear as well as an optimal anticoagulant treatment in males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2.The aim of this study was to compare the predictive value of the CHA2DS2-VASc scale and other scales to estimate the risk of LAAT formation in AF patients treated with non-vitamin K oral anticoagulants (NOACs) and to assess the prevalence of thrombi in patients at intermediate risk of stroke.The observational study included consecutive patients with a diagnosis of non-valvular AF treated with NOACs, admitted to 3 high-reference institutions between 2013 and 2018. All individuals underwent transoesophageal echocardiography before cardioversion or ablation.Out of 1163 enrolled AF patients (62.1% male, mean age 62 years) the LAAT had been detected in 50 individuals (4.3%). Among patients with LAAT, 1 patient (2.0%) was classified as a low-risk category, 9 (18.0%) were at intermediate-risk, and 40 (80.0%) were at high risk of thromboembolic complications according to CHA2DS2-VASc scale. All patients were treated with NOACs: 51.0% rivaroxaban, 47.1% dabigatran, and 1.9% apixaban.Patients at intermediate stroke-risk with detected LAAT had higher R2CHADS2 score (2.1 ± 1.2 vs 1.2 ± 0.8, P = .007), higher CHA2DS2-VASc-RAF score (6.4 ± 4.4 vs 3.7 ± 2.6, P = .027) and more often had an estimated glomerular filtration rate below 56 mL/min/1.73 m (44.4% vs 13.2%, P = .026) compared to patients without LAAT. The receiver operating characteristics revealed that the CHA2DS2-VASc-RAF scale had better predictive ability to distinguish between patients with and without LAAT in the study group than CHA2DS2-VASc (P = .0006), CHADS2 (P = .0006) and R2CHADS2 scale (P = .0140).The CHA2DS2-VASc scale should be supplemented with an assessment of renal function and form of AF to improve stroke risk estimation. The application of additional scales to estimate the risk of LAAT might be especially useful among males with a CHA2DS2-VASc score of 1 and females with a CHA2DS2-VASc score of 2. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/32569181/Does_the_CHA2DS2-VASc_scale_sufficiently_predict_the_risk_of_left_atrial_appendage_thrombus_in_patients_with_diagnosed_atrial_fibrillation_treated_with_non-vitamin_K_oral_anticoagulants L2 - https://doi.org/10.1097/MD.0000000000020570 DB - PRIME DP - Unbound Medicine ER -