Relation Between the CHA2DS2-VASc Score and Left Atrial Appendage Thrombus in Patients with Non-valvular Atrial Fibrillation under Real-world Anticoagulation with Warfarin
Year: 2014
Type: article
Study design: Observational Study
Abstract: Objective: The goal of this study was to investigate the relation between the CHA2DS2-VASc score and left atrial appendage (LAA) thrombus in Japanese patients with NVAF under real-world anticoagulation with warfarin.Methods: We retrospectively investigated 408 consecutive patients with NVAF who were referred to our hospital between April 2006 and December 2012.After their initial visit to our hospital, all patients had their CHA2DS2-VASc scores calculated and then underwent transthoracic/transesophageal echocardiography (TTE/ TEE) for the evaluation of LAA thrombus to facilitate the clinical decision-making regarding anticoagulation, cardioversion, pulmonary vein isolation (PVI) by catheter ablation, or antiarrhythmic drug therapy.We investigated the relationship between the CHA2DS2-VASc score and LAA thrombus and determined the predictor of LAA thrombus by multivariate analysis.Results: Ninety-one percent of all patients had already received warfarin as part of regular clinical practice, but LAA thrombus was found in 3.7% of the patients with a CHA2DS2-VASc score of 0 or 1 and in 17.3% of the patients with a CHA2DS2-VASc score≧2 (p < 0.001).The prevalence of LAA thrombus increased with ascending CHA2DS2-VASc score, both in the 215 patients with paroxysmal AF (score 0 [0%], 1 [1.8%], 2 [5.3%], 3 [4.3%],4-9 [4.7%]) and in the 193 patients with persistent/chronic AF (score 0 [9.4%], 1 [6.5%], 2 [25.6%], 3 [18.2%],4-9 [39.5%]).On multivariate analysis, a higher CHA2DS2-VASc score, persistent/chronic AF, a history of congestive heart failure (CHF) and of stroke/transient ischemic attack (TIA) were significantly associated with LAA thrombus.Conclusion: LAA thrombus may occur with greater frequency in high-risk CHA2DS2-VASc score patients.Adequate anticoagulation should be ensured in patients with NVAF who have a CHA2DS2-VASc score≧2, a history of CHF or stroke/TIA, or the persistent/chronic type of arrhythmia.
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2161389363