Anticoagulant Therapy in Atrial Fibrillation for Stroke Prevention: Assessment of Agreement Between Clinicians’ Decision and CHA2DS2-VASc and HAS-BLED Scores
- 40 Downloads
To prevent stroke, anticoagulants should be administered after calculation of CHA2DS2-VASc and HAS-BLED scores in patients with Atrial Fibrillation (AF); nonetheless, these scores are sometimes neglected in clinical settings.
The present study was designed to assess agreement of anticoagulant therapy according to clinicians and CHA2DS2-VASc and HAS-BLED scores in Iranian AF patients in Moddares Hospital.
AF patients were diagnosed according to clinical history, clinical examination, and electrocardiogram. Data including the anticoagulant prescription according to clinicians were recorded. CHA2DS2-VASc and HAS-BLED scores were then calculated for each patient. Agreement of anticoagulant therapy according to clinicians and CHA2DS2-VASc and HAS-BLED scores was analyzed using Cohen’s kappa coefficient.
97.5% of the patients (n = 117) were appropriately (according CHA2DS2-VASc and HAS-BLED scores) treated with anticoagulants by clinicians, notwithstanding a 2.5% of patients with inappropriate anticoagulant therapy (n = 3). The Cohen’s kappa coefficient was 0.81 (P = 0.0).
The findings of the present study suggest an almost perfect agreement between anticoagulant therapy according to clinicians and that according to CHA2DS2-VASc and HAS-BLED scores in the studied population.
KeywordsAtrial fibrillation Clinician decision CHA2DS2-VASc HAS-BLED Agreement assessment
We thank Shahid Beheshti University of Medical Sciences for its support.
Compliance with Ethical Standards
Conflict of interest
The authors declare that there is no conflict of interest regarding the present study.
The present study was approved by local ethics committee.
Written informed consent was obtained from each patient.
- 2.Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna WP, et al. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation. 2006;114(2):119–25. doi: 10.1161/circulationaha.105.595140.CrossRefPubMedGoogle Scholar
- 13.Olesen JB, Torp-Pedersen C, Hansen ML, Lip GY. The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0–1: a nationwide cohort study. Thromb Haemost. 2012;107(6):1172–9. doi: 10.1160/th12-03-0175.CrossRefPubMedGoogle Scholar
- 15.Srivastava A, Hudson M, Hamoud I, Cavalcante J, Pai C, Kaatz S. Examining warfarin underutilization rates in patients with atrial fibrillation: detailed chart review essential to capture contraindications to warfarin therapy. Thromb J. 2008;6(1):6. doi: 10.1186/1477-9560-6-6.CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Boulanger L, Kim J, Friedman M, Hauch O, Foster T, Menzin J. Patterns of use of antithrombotic therapy and quality of anticoagulation among patients with non-valvular atrial fibrillation in clinical practice. Int J Clin Pract. 2006;60(3):258–64. doi: 10.1111/j.1368-5031.2006.00790.x.CrossRefPubMedGoogle Scholar
- 20.Gandolfo C, Balestrino M, Burrone A, Del Sette M, Finocchi C. Stroke due to atrial fibrillation and the attitude to prescribing anticoagulant prevention in Italy. A prospective study of a consecutive stroke population admitted to a comprehensive stroke unit. J Neurol. 2008;255(6):796–802. doi: 10.1007/s00415-008-0615-2.CrossRefPubMedGoogle Scholar
- 22.Partington SL, Abid S, Teo K, Oczkowski W, O’Donnell MJ. Pre-admission warfarin use in patients with acute ischemic stroke and atrial fibrillation: the appropriate use and barriers to oral anticoagulant therapy. Thromb Res. 2007;120(5):663–9. doi: 10.1016/j.thromres.2006.12.019.CrossRefPubMedGoogle Scholar