Deans' stroke musings: CHADS2 predicts problems in AF patients taking dabigatran, warfarin

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, November 25, 2011

CHADS2 predicts problems in AF patients taking dabigatran, warfarin

make sure you talk to your doctor on the scoring for this. More charts at the link.
http://www.theheart.org/article/1317123.do?utm_campaign=newsletter&utm_medium=email&utm_source=20111125_TopStories_EN
In patients with atrial fibrillation, a higher CHADS₂ score is associated with increased risk for stroke or systemic embolism, bleeding, and death, even with optimal anticoagulation with warfarin or dabigatran, according to a subgroup analysis of the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial [1].

In anticoagulated patients, "the commonly used CHADS₂ risk score not only predicts stroke (as it was developed for), but also mortality and major bleeding," said first author Dr Jonas Oldgren (Uppsala University Hospital, Sweden).

The analysis was published November 15 in Annals of Internal Medicine.

Prediction rule

CHADS₂ is a simple and validated clinical prediction rule for estimating stroke risk in patients with atrial fibrillation not on anticoagulants, the authors note in their paper. Its value in predicting thrombotic and bleeding complications in patients on anticoagulant therapy is unclear.

Oldgren and colleagues used data from the RE-LY trial to assess thrombotic and bleeding risk according to baseline CHADS₂ score.

The study involved 18 112 patients with atrial fibrillation at risk of stroke randomized to dabigatran (Pradaxa, Boehringer Ingelheim), 110 mg or 150 mg twice daily, or warfarin at a dose adjusted to an international normalized ratio (INR) of 2.0-3.0 for a median of two years.

The main RE-LY results, published in 2009 in the New England Journal of Medicine, showed that the rates of stroke or systemic embolism and death each decreased by 0.5% per year with dabigatran 150 mg twice daily compared with dose-adjusted warfarin [2]. Rates of major bleeding did not differ, but intracranial bleeding was less common with dabigatran.

The CHADS₂ risk score assigns 1 point for a history of congestive heart failure, hypertension, diabetes, or being older than 75 years, and 2 points for a history of stroke or transient ischemic attack. In the RE-LY cohort, 5775 patients had CHADS₂ scores of 0-1, 6455 had scores of 2, and 5882 patients had scores of 3-6. Even on anticoagulation treatment, the risk of the primary outcome of stroke or systemic embolism increased with increasing CHADS₂ score, the authors report.