|
||
|
|
|
||
|
|
In recognition of the differential roles played by gender in the risk profiles and efficacy and safety results, the most important risk scoring system at present, CHADS2 has been updated as the CHAD2DS2 vascular score (CHA2DS2-VASc), principally by the European community. [126] The updated CHA2DS2-VASc takes gender into account in calculating risk, whereas the CHADS2 score does not (Figure).
Moving forward, the fact that gender is a significant factor in CHA2DS2-VASc, especially in patients with a CHADS2 score of 0 or 1, may give us the opportunity to be more accurate in risk stratifying patients, especially women. One recommendation, as discussed by Dr Reiffel, would be to calculate the CHA2DS2-VASc score only in patients with a simpler CHADS2 score of 0 or 1; at a CHADS2 score of ≥2, the mandate to initiate antithrombin therapy is clear.
French WJ. Am J Med 2013; 126: 00-00.
[CHADS2 = Congestive heart failure, Hypertension, Age ≥75, Diabetes, Stroke (doubled); CHA2DS2-VASc = Congestive heart failure or left ventricular dysfunction, Hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled)-Vascular disease, Age 65–74, Sex category (female)]
[126] Camm AJ, Lip GY, De Caterina R, et al; ESC Committee for Practice Guidelines (CPG),. 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. Eur Heart J. 2012;33:2719-2747.