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How do we compute the risk of thromboembolism? The Figure lists the principal guidelines that have been promulgated by the leading professional organizations. [23] [34] [35] [36] [37] [38] Of these it is the CHADS2 scoring system, highlighted in yellow in the top part of the Figure, that has become the most commonly used at this time because it has been promulgated on the basis of retrospective evidence and then confirmed prospectively. The risk factors that almost all of these guidelines have in common are listed in the bottom part of the Figure. Other factors that are generally seen as increasing risk of thromboembolism include female gender and chronic kidney disease; in addition, isolated hypertension (in the absence of other cardiovascular disease) or coronary artery disease with preserved left-ventricular function incur intermediate risk for thromboembolism.
Reiffel JA. Am J Med 2013; 126: 00-00.
[23] Fuster V, Rydén LE, Cannom DS, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; European Society of Cardiology Committee for Practice Guidelines; European Heart Rhythm Association; Heart Rhythm Society. ACC/AHA/ESC 2006 Guidelines 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 European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114:e257-e354.
[34] You JJ, Singer DE, Howard PA, et al; American College of Chest Physicians. Antithrombotic therapy for atrial fibrillation: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e531S-e575S.
[35] Hart RG, Halperin JL, Pearce LA, et al; Stroke Prevention in Atrial Fibrillation Investigators. Lessons from the Stroke Prevention in Atrial Fibrillation trials. Ann Intern Med. 2003;138:831-838.
[36] Stroke Prevention in Atrial Fibrillation Investigators. Risk factors for thromboembolism during aspirin therapy in patients with atrial fibrillation: The Stroke Prevention in Atrial Fibrillation study. J Stroke Cerebrovasc Dis. 1995;5:147-157.
[37] Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med. 1994;154:1449-1457.
[38] Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285:2864-2870.