COMMENTARY

CHA2DS2VASC: Useful Beyond A-Fib?

Samuel Z. Goldhaber, MD

Disclosures

June 19, 2014

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Hello. This is Dr. Sam Goldhaber for the Clot Blog at theheart.org on Medscape, speaking to you from the American College of Cardiology Scientific Sessions in Washington, DC.

Today I'm going to discuss the CHA2DS2VASC score and how it may be able to teach us and help us predict risk for stroke in patients other than those with established atrial fibrillation. It turns out that, looking at certain population studies, the CHA2DS2VASC score might be predictive of stroke in patients in normal sinus rhythm.[1] That's not surprising if you think about why patients develop atrial fibrillation: It's because of congestive heart failure, hypertension, older age, diabetes, or vascular disease such as coronary artery disease. These might predispose to stroke even in the absence of atrial fibrillation.

Let's take this a step further. Suppose we find that the higher the CHA2DS2VASC score, the more likely the occurrence of stroke. If this is the case, might it not be possible to prevent stroke with anticoagulation in patients who have a high CHA2DS2VASC score, but who are in normal sinus rhythm? This is a question that remains to be answered. In addition, the CHA2DS2VASC score may be able to predict other cardiovascular diseases, such as pulmonary embolism. Some studies suggest this as well.[2]

We can think of the CHA2DS2VASC score as a tool for assessing the risk for stroke in patients with atrial fibrillation, but if we think outside of the box, it's possible that the CHA2DS2VASC score may give us clues about who is going to suffer a stroke in the future, even if that individual is in normal sinus rhythm at the time the CHA2DS2VASC score is calculated.

This is Dr. Sam Goldhaber, signing off for the Clot Blog.

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