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Ischemic Stroke, Brain Attack


 

Prediction of ischemic stroke:

A CHADS2 score is the most accurate tool for prediction of stroke in patients with atrial fibrillation (65). Calculating a CHADS2 score uses the following scoring system (129):

  • 2 points for previous stroke or TIA (transient ischemic attack)
  • 1 point for recent CHF (congestive heart failure)
  • 1 point for hypertension
  • 1 point for age 75 years or older
  • 1 point for diabetes

 

Rate of stroke by CHADS2 score:

The rate of stroke occurrence without anticoagulation per year depends upon the CHADS2 score as follows (65):

  • CHADS2 score of 0: 1.9% per year.
  • CHADS2 score of 1: 2.8% per year.
  • CHADS2 score of 2: 4.0% per year.
  • CHADS2 score of 3: 5.9% per year.
  • CHADS2 score of 4: 8.5% per year.
  • CHADS2 score of 5: 12.5% per year.
  • CHADS2 score of 6: 18.2% per year.

 

Treatment for prevention of ischemic stroke in patients with atrial fibrillation:

  • The patient’s cardiologist and primary care provider are responsible for recommending treatment for the prevention of stroke. According to the American Heart Association/American Stroke Association (AHA/ASA) basic treatment guidelines are as follows (64):
    • CHADS2 score of 0: No treatment or aspirin is recommended.
    • CHADS2 score of 1: Antithrombotic therapy choice by the physician varies.
    • CHADS2 score of 2 or higher: Anticoagulation is recommended for atrial fibrillation to prevent stroke.

 

Warfarin, aspirin, and clopidogrel use in risk of stroke:

Warfarin with dose changes to maintain therapeutic range reduced the risk of stroke in atrial fibrillation from an average of 4.5% to 1.4%. Aspirin reduces the risk of stroke in atrial fibrillation by about 21%. Benefit verses risks of bleeding or adverse effects from anti-thrombotic therapy should be discussed in detail with the physician. The risk of severe bleeding episodes while taking warfarin was about 1.3% per year, and with aspirin, about 1% per year. Therapy with both aspirin and clopidogrel were demonstrated to be about the same severe bleeding risk as warfarin with a small reduction in stroke rates.

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