| 词条 | CHA2DS2–VASc score | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 释义 |
| name = CHA2DS2–VASc score | image = | alt = | caption = | pronounce = |purpose = risk of stroke (for non-rheumatic atrial fibrillation) | synonyms = | reference_range = | calculator = | DiseasesDB = | ICD10 = | ICD9 = | ICDO = | MedlinePlus = | eMedicine = | MeshID = | OPS301 = | LOINC = }} The CHADS2 score and its updated version, the CHA2DS2-VASc score, are clinical prediction rules for estimating the risk of stroke in patients with non-rheumatic atrial fibrillation (AF), a common and serious heart arrhythmia associated with thromboembolic stroke. Such a score is used to determine whether or not treatment is required with anticoagulation therapy or antiplatelet therapy,[1] since AF can cause stasis of blood in the upper heart chambers, leading to the formation of a mural thrombus that can dislodge into the blood flow, reach the brain, cut off supply to the brain, and cause a stroke. A high score corresponds to a greater risk of stroke, while a low score corresponds to a lower risk of stroke. The CHADS2 score is simple and has been validated by many studies.[2] In clinical use, the CHADS2 score (pronounced "chads two") has been superseded by the CHA2DS2-VASc score ("chads vasc"[3]), which gives a better stratification of low-risk patients. CHADS2The CHADS2 score does not include some common stroke risk factors, and its various pros/cons have been carefully discussed.[4] Adding together the points that correspond to the conditions that are present results in the CHADS2 score, that is used to estimate stroke risk.
CHA2DS2-VAScTo complement the CHADS2 score, by the inclusion of additional 'stroke risk modifier' risk factors, the CHA2DS2-VASc-score has been proposed.[6] In clinical use, the CHADS2 score has been superseded by the CHA2DS2-VASc score, which gives a better stratification of low-risk patients. The CHADS2 score has been outperformed by the CHA2DS2-VASc in multiple patient groups including patients with AF who are receiving outpatient elective electrical cardioversion.[7]
Thus, the CHA2DS2-VASc score is a refinement of CHADS2[6][8] score and extends the latter by including additional common stroke risk factors, that is, age 65–74, female gender and vascular disease.[9] In the CHA2DS2-VASc score, 'age 75 and above' also has extra weight, with 2 points. The maximum CHADS2 score is 6, whilst the maximum CHA2DS2-VASc score is 9 (not 10, as might be expected from simply adding up the columns; the maximum score for age is 2 points). {{clear}}
Major guidelines have used the above fixed annual stroke risk as a guideline of starting anticoagulant treatment; where the ischemic stroke risk of more than 1% to 2% should be an indication to start an anticoagulant therapy. However, actual risk of getting stroke varies according to sampling method and geographical regions, as well as use of appropriate study analysis methodology.[11] A meta-analysis of various studies in 2015 shown that annual stroke risk is less than 1% in 13 of the 17 studies for CHA2DS2–VASc score of 1, 6 out of 15 studies reported risk of 1 to 2% and 5 out of 15 studies reported risk of more than 2% for CHA2DS2–VASc score of 2.[12] Nevertheless, stroke rates vary by study setting (hospital vs community), population (trial vs general), ethnicity, etc. Some studies included in the metaanalysis include females with score 1 by virtue of gender (who are low risk), into the aggregate rates; others included do not account for followup anticoagulation use (thus lowering rates) and were analysed by excluding all patients ever started on anticoagulants ('conditioning on the future' error).[13] The CHA2DS2-VASc Score has shown increasing popularity over time while the CHADS2 has shown decreasing popularity[14], which could "partly be related to introduction of guidelines recommending the use of the CHA2DS2-VASc score for stroke risk stratification".[14] Treatment recommendationsThe CHA2DS2-VASc score has been used in the 2012 European Society of Cardiology guidelines for the management of atrial fibrillation.[15][16][20] The 2014 American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society guidelines also recommend use of the CHA2DS2-VASc score.[17] The European Society of Cardiology (ESC),[18] and National Institute for Health and Care Excellence (NICE)[19] guidelines recommend that if the patient has a CHA2DS2-VASc score of 2 and above, oral anticoagulation therapy (OAC) with a Vitamin K Antagonist (VKA, e.g. warfarin with target INR of 2-3) or one of the non-VKA oral anticoagulant drugs (NOACs, e.g. dabigatran, rivaroxaban, edoxaban, or apixaban) is recommended. If the patient is 'low risk' using the CHA2DS2-VASc score (that is, 0 in males or 1 in females), no anticoagulant therapy is recommended. In males with 1 stroke risk factor (that is, a CHA2DS2-VASc score=1), antithrombotic therapy with OAC may be considered, and people values and preferences should be considered.[20] Even a single stroke risk factor confers excess risk of stroke and mortality, with a positive net clinical benefit for stroke prevention with oral anticoagulation, when compared to no treatment or aspirin.[21] As mentioned above, thromboembolic event rates differ according to various guideline treatment thresholds and methodological approaches.[22] AnticoagulationTreatment recommendations based on the CHA2DS2-VASc score are shown in the following table:
Based on the ESC guidelines on Atrial Fibrillation, oral anticoagulation is recommended or preferred for patients with one or more stroke risk factors (i.e. a CHA2DS2-VASc score of ≥1 in males, or ≥2 in females).[24] This is consistent with a recent decision analysis model showing how the 'tipping point' on the decision to anticoagulate has changed with the availability of the 'safer' NOAC drugs, where the threshold for offering stroke prevention (i.e. oral anticoagulation) is a stroke rate of approximately 1%/year.[18][25] Those patients recommended for stroke prevention treatment via oral anticoagulation, choice of drug (i.e. between a Vitamin K Antagonist and Non-Vitamin K Antagonist Oral Anticoagulant (NOAC)) can be evaluated using the SAMe-TT2R2 score to help decision-making on the most appropriate oral anticoagulant.[26][27] Bleeding risk{{Main|HAS-BLED}}Stroke risk assessment should always include an assessment of bleeding risk. This can be done using validated bleeding risk scores, such as the HEMORR2HAGES or HAS-BLED scores. The HAS-BLED score is recommended in guidelines, to identify the high risk patient for regular review and followup and to address the reversible risk factors for bleeding (e.g. uncontrolled hypertension, labile INRS, excess alcohol use or concomitant aspirin/NSAID use).[23] If the patient is taking warfarin, then knowledge of INR control is needed to assess the 'labile INR' criterion in HAS-BLED; otherwise for a non-warfarin patient, this criterion scores zero. A high HAS-BLED score is not a reason to withhold anticoagulation. Also, when compared to HAS-BLED, other bleeding risk scores that did not consider 'labile INR' would significantly underperform in predicting bleeding on warfarin, and would often inappropriately categorise many patients who sustained bleeds as 'low risk'.[28] References1. ^{{cite journal | title=Selecting patients with atrial fibrillation for anticoagulation: stroke risk stratification in patients taking aspirin | journal=Circulation | year=2004 | volume=110 | issue=16 | pages=2287–92 | vauthors=Gage BF, van Walraven C, Pearce L | pmid=15477396 | doi=10.1161/01.CIR.0000145172.55640.93 |display-authors=etal}} 2. ^1 {{cite journal |vauthors=Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ |title=Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation |journal=JAMA |volume=285 |issue=22 |pages=2864–70 |year=2001 |pmid=11401607 |doi=10.1001/jama.285.22.2864}} 3. ^Professor Gregory Lip Discusses CHA2DS2-VASc Tool for Predicting Stroke Risk in Atrial Fibrillation 4. ^Karthikeyan G, Eikelboom JW. The CHADS2 score for stroke risk stratification in atrial fibrillation--friend or foe? Thromb. Haemost. 2010 Jul 5;104(1):45-8. 5. ^{{cite web|url=http://www.cardiology.org/tools/risk_of_stroke_AF.html |title=Risk of Stroke with AF |accessdate=2007-09-14 |publisher=VA Palo Alto Medical Center and at Stanford University: the Sportsmedicine Program and the Cardiomyopathy Clinic }} 6. ^1 {{cite journal |vauthors=Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ | date = Feb 2010 | title = Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation | url = | journal = Chest | volume = 137 | issue = 2| pages = 263–72 | doi=10.1378/chest.09-1584 | pmid=19762550}} 7. ^{{cite journal | vauthors= Yarmohammadi H, Varr BC, Puwanant S, Lieber E, Williams SJ, Klostermann T, Jasper SE, Whitman C, Klein AL | title=Role of CHADS2 score in evaluation of thromboembolic risk and mortality in patients with atrial fibrillation undergoing direct current cardioversion (from the ACUTE Trial Substudy). | journal= Am J Cardiol | year=2012 | volume=110 | issue=2| pages=222–26| doi= 10.1016/j.amjcard.2012.03.017| pmid=22503581}} 8. ^{{cite journal|last1=Sandhu|first1=R. K.|last2=Bakal|first2=J. A.|last3=Ezekowitz|first3=J. A.|last4=McAlister|first4=F. A.|title=Risk stratification schemes, anticoagulation use and outcomes: the risk-treatment paradox in patients with newly diagnosed non-valvular atrial fibrillation|journal=Heart|date=10 November 2011|volume=97|issue=24|pages=2046–50|doi=10.1136/heartjnl-2011-300901|doi-access=free|pmid=22076011|url=http://heart.bmj.com/content/97/24/2046|accessdate=12 February 2017}} 9. ^{{cite web|title=UCSF Cardiology {{!}} Atrial Fibrillation Medical Management|url=https://cardiology.ucsf.edu/care/clinical/electro/fib-management.html|website=cardiology.ucsf.edu|accessdate=12 February 2017}} 10. ^{{cite journal |url=http://eurheartjsupp.oxfordjournals.org/content/10/suppl_H/H4/T2.expansion.html |title=Prevention of stroke in patients with atrial fibrillation: current strategies and future directions |journal=European Heart Journal Supplements |volume=10 |pages=H4–H10 |publisher=British Medical Journal |accessdate=30 December 2012|doi=10.1093/eurheartj/sun029 |year=2008 |last1=Hohnloser |first1=S. H. |last2=Duray |first2=G. Z. |last3=Baber |first3=U. |last4=Halperin |first4=J. L. }} 11. ^{{cite journal|last1=Nielsen|first1=Peter B|title=Stroke and thromboembolic event rates in atrial fibrillation according to different guideline treatment thresholds: A nationwide cohort study.|journal=Scientific Reports|date=2016|volume=6|page=27410|doi=10.1038/srep27410|pmid=27265586|pmc=4893655|bibcode=2016NatSR...627410N}} 12. ^{{cite journal|last1=Gene R|first1=Quinn|last2=Olivia|first2=N Severdija|last3=Yuchiao|first3=Chang|last4=Daniel|first4=E Singer|title=Wide Variation in Reported Rates of Stroke Across Cohorts of Patients with Atrial Fibrillation|journal=Circulation|date=31 October 2016|volume=135|issue=3|pages=208–19|doi=10.1161/CIRCULATIONAHA.116.024057|pmid=27799272}} 13. ^{{cite journal|last1=Nielsen|first1=P|last2=Lip|first2=G| date = 2017 | title=Adding Rigor to Stroke Rate Investigations in Patients With Atrial Fibrillation.|journal=Circulation|volume=135|issue=3|pages=220–223|doi=10.1161/CIRCULATIONAHA.116.025944|pmid=28093493}} 14. ^1 {{cite journal |last1=Lip |first1=GY |last2=Habboushe |first2=J |last3=Altman |first3=C |title=Time trends in use of the CHADS2 and CHA2DS2-VASc scores, and the geographical and specialty uptake of these scores from a popular online clinical decision tool and medical reference |journal=International Journal of Clinical Practice |volume=73 |issue=2 |date=2019 |pages=e13280 |doi=10.1111/ijcp.13280 |pmid=30281876 }} 15. ^1 {{cite journal |vauthors=Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P | date = Oct 2012 | title = 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association | url = | journal = Europace | volume = 14 | issue = 10| pages = 1385–413 | doi = 10.1093/europace/eus305 | pmid = 22923145 }} 16. ^{{Cite journal |last=Camm |first=A. J. |last2=Kirchhof |first2=P. |last3=Lip |first3=G. Y. H. |last4=Schotten |first4=U. |last5=Savelieva |first5=I. |last6=Ernst |first6=S. |last7=Van Gelder |first7=I. C. |last8=Al-Attar |first8=N. |last9=Hindricks |first9=G. |displayauthors=29 |date=Oct 2010 |title=Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) |journal=Eur Heart J |volume=31 |issue=19 |pages=2369–429 |doi=10.1093/eurheartj/ehq278 |pmid=20802247 |last10=Prendergast |first10=B. |last11=Heidbuchel |first11=H. |last12=Alfieri |first12=O. |last13=Angelini |first13=A. |last14=Atar |first14=D. |last15=Colonna |first15=P. |last16=De Caterina |first16=R. |last17=De Sutter |first17=J. |last18=Goette |first18=A. |last19=Gorenek |first19=B. |last20=Heldal |first20=M. |last21=Hohloser |first21=S. H. |last22=Kolh |first22=P. |last23=Le Heuzey |first23=J.-Y. |last24=Ponikowski |first24=P. |last25=Rutten |first25=F. H. |last26=Vahanian |first26=A. |last27=Auricchio |first27=A. |last28=Bax |first28=J. |last29=Ceconi |first29=C. |last30=Dean |first30=V.}} 17. ^{{cite journal |vauthors=January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW | date = Dec 2014 | title = 2014 AHA/ACC/HRS guideline 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 Heart Rhythm Society | pmid = 24685669 | journal = J Am Coll Cardiol | volume = 64 | issue = 21| pages = e1–76 | doi=10.1016/j.jacc.2014.03.022}} 18. ^1 2 {{cite journal|last1=Kirchhof|first1=Paulus|last2=Benussi|first2=Stefano|last3=Kotecha|first3=Dipak|last4=Ahlsson|first4=Anders|last5=Atar|first5=Dan|last6=Casadei|first6=Barbara|last7=Castella|first7=Manuel|last8=Diener|first8=Hans-Christoph|last9=Heidbuchel|first9=Hein|last10=Hendriks|first10=Jeroen|last11=Hindricks|first11=Gerhard|last12=Manolis|first12=Antonis S.|last13=Oldgren|first13=Jonas|last14=Popescu|first14=Bogdan Alexandru|last15=Schotten|first15=Ulrich|last16=Van Putte|first16=Bart|last17=Vardas|first17=Panagiotis|last18=Agewall|first18=Stefan|last19=Camm|first19=John|last20=Baron Esquivias|first20=Gonzalo|last21=Budts|first21=Werner|last22=Carerj|first22=Scipione|last23=Casselman|first23=Filip|last24=Coca|first24=Antonio|last25=De Caterina|first25=Raffaele|last26=Deftereos|first26=Spiridon|last27=Dobrev|first27=Dobromir|last28=Ferro|first28=José M.|last29=Filippatos|first29=Gerasimos|last30=Fitzsimons|first30=Donna|last31=Gorenek|first31=Bulent|last32=Guenoun|first32=Maxine|last33=Hohnloser|first33=Stefan H.|last34=Kolh|first34=Philippe|last35=Lip|first35=Gregory Y. H.|last36=Manolis|first36=Athanasios|last37=McMurray|first37=John|last38=Ponikowski|first38=Piotr|last39=Rosenhek|first39=Raphael|last40=Ruschitzka|first40=Frank|last41=Savelieva|first41=Irina|last42=Sharma|first42=Sanjay|last43=Suwalski|first43=Piotr|last44=Tamargo|first44=Juan Luis|last45=Taylor|first45=Clare J.|last46=Van Gelder|first46=Isabelle C.|last47=Voors|first47=Adriaan A.|last48=Windecker|first48=Stephan|last49=Zamorano|first49=Jose Luis|last50=Zeppenfeld|first50=Katja|title=2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS|journal=European Heart Journal|date=7 October 2016|volume=37|issue=38|pages=2893–2962|doi=10.1093/eurheartj/ehw210|pmid=27567408|url=http://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Atrial-Fibrillation-Management|accessdate=12 February 2017}} 19. ^{{cite web|title=Atrial fibrillation: management {{!}} Guidance and guidelines {{!}} NICE|url=https://www.nice.org.uk/guidance/cg180|website=www.nice.org.uk|accessdate=12 February 2017|date=June 2014}} 20. ^{{cite journal|last1=Joundi|first1=RA|last2=Cipriano|first2=LE|last3=Sposato|first3=LA|last4=Saposnik|first4=G|last5=Stroke Outcomes Research Working|first5=Group|title=Ischemic Stroke Risk in Patients With Atrial Fibrillation and CHA2DS2-VASc Score of 1: Systematic Review and Meta-Analysis.|journal=Stroke: A Journal of Cerebral Circulation|date=May 2016|volume=47|issue=5|pages=1364–7|pmid=27026630|doi=10.1161/strokeaha.115.012609}} 21. ^{{cite journal |last1=Fauchier |first1=L |last2= Clementy |first2=N |last3=Bisson |first3=A |last4=Ivanes |first4=F |last5=Angoulvant |first5=D |last6=Babuty |first6=D |title=Should Atrial Fibrillation Patients With Only 1 Nongender-Related CHA2DS2-VASc Risk Factor Be Anticoagulated? | journal=Stroke | year= 2016 | doi=10.1161/STROKEAHA.116.013253 | pmid=27231269 | volume=47 |issue=7 | pages=1831–6}} 22. ^{{cite journal |author1=Nielsen P |author2=Larsen TB |author3=Skjøth F|display-authors=et al | year = 2016 | title = Stroke and thromboembolic event rates in atrial fibrillation according to different guideline treatment thresholds: A nationwide cohort study | url = | journal = Sci Rep | volume = 6 | issue = | page = 27410 | doi = 10.1038/srep27410 |pmid=27265586 |pmc=4893655 |bibcode=2016NatSR...627410N }} 23. ^1 {{cite journal| author = National Clinical Guideline Centre | location = London| title = Atrial Fibrillation: The Management of Atrial Fibrillation. |publisher = National Institute for Health and Care Excellence |date=June 2014 | pmid= 25340239 }} 24. ^{{cite journal |vauthors=Lip GY, Lane DA | year = 2015 | title = Stroke prevention in atrial fibrillation: a systematic review | url = | journal = JAMA | volume = 313 | issue = 19| pages = 1950–62 | doi=10.1001/jama.2015.4369 | pmid=25988464}} 25. ^{{cite journal |vauthors=Eckman MH, Singer DE, Rosand J, Greenberg SM | date = Jan 2011 | title = Moving the tipping point: the decision to anticoagulate patients with atrial fibrillation | url = | journal = Circ Cardiovasc Qual Outcomes | volume = 4 | issue = 1| pages = 14–21 | doi=10.1161/circoutcomes.110.958108| pmid = 21139092 | pmc = 3058150}} 26. ^{{cite journal |vauthors=Apostolakis S, Sullivan RM, Olshansky B, Lip GY | date = Nov 2013 | title = Factors affecting quality of anticoagulation control among patients with atrial fibrillation on warfarin: the SAMe-TT₂R₂ score | doi = 10.1378/chest.13-0054 | pmid = 23669885 | journal = Chest | volume = 144 | issue = 5| pages = 1555–63 }} 27. ^{{cite journal|last1=Proietti|first1=Marco|last2=Lip|first2=Gregory Y.H.|title=Simple decision-making between a vitamin K antagonist and a non-vitamin K antagonist oral anticoagulant: using the SAMe-TT2R2 score|journal=European Heart Journal - Cardiovascular Pharmacotherapy|date=July 2015|volume=1|issue=3|pages=150–152|doi=10.1093/ehjcvp/pvv012|doi-access=free|pmid=27533987}} 28. ^{{Cite journal |last=Proietti |first=Marco |last2=Senoo |first2=Keitaro |last3=Lane |first3=Deirdre A. |last4=Lip |first4=Gregory Y. H. |date=Apr 2016 |title=Major Bleeding in Patients with Non-Valvular Atrial Fibrillation: Impact of Time in Therapeutic Range on Contemporary Bleeding Risk Scores |journal=Sci. Rep. |volume=6 |page=24376 |doi=10.1038/srep24376 |pmc=4828703 |pmid=27067661|bibcode=2016NatSR...624376P }} External links
2 : Stroke|Medical scoring system |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 随便看 |
|
开放百科全书收录14589846条英语、德语、日语等多语种百科知识，基本涵盖了大多数领域的百科知识，是一部内容自由、开放的电子版国际百科全书。