Innovations in anticoagulation for stroke prevention

June 13, 2012

Nice, 13 June 2012: New scientific findings in anticoagulation for stroke prevention are paving the way for updates to the European Society of Cardiology (ESC) Guidelines for the management of atrial fibrillation.

Some of these findings were presented during the European Heart Rhythm Association (EHRA) sessions at Cardiostim 2012, 13-16 June, in Nice, France. Cardiostim is an international scientific congress in the field of electrophysiology and cardiac techniques. It is organised in collaboration with the ESC and EHRA, which is a registered branch of the ESC. Link to Cardiostim

Experts from EHRA showcased the latest science in electrophysiology and cardiac techniques during 30 EHRA sessions at Cardiostim. Professor Gregory YH Lip (Birmingham, UK) and other EHRA members presented the most up to date findings in the field of anticoagulation for stroke prevention in atrial fibrillation.

The CHA2DS22-VASc score to assess stroke risk has now been validated in different independent populations. "The CHA2DS2-VASc score outperforms other stroke risk scores including the older CHADS2 score in identifying very low risk patients who do not need any antithrombotic therapy," says Professor Lip. "And in some of the validations the CHA2DS2-VASc score outperforms the CHADS2 score in predicting those who get a stroke subsequently."

In the past, patients with a CHADS2 score of 0 were considered to be at low risk of stroke. But when these patients were substratified using the CHA2DS2-VASc score, these patients had stroke rates between 0.8-3.2% per year, if untreated (1). Professor Lip says: "Thus, those patients with a CHADS2 score of 0 are not low risk at all and show that the CHADS2 score does not accurately define low risk patients."

A net clinical benefit analysis balancing ischaemic stroke against intracranial bleeding based on a dataset of more than 180,000 patients with atrial fibrillation in Sweden found that patients with a CHA2DS2-VASc score >1 had a positive net clinical benefit when they were anticoagulated. The findings were irrespective of bleeding risk, which was assessed by the HAS-BLED score (2).

The effectiveness of the HAS-BLED score in assessing major bleeding risk (and the risk of intracranial haemorrhage) has been confirmed in numerous cohorts of patients with atrial fibrillation who are taking oral anticoagulation (3). The score also predicted cardiovascular events and mortality. Professor Lip says: "Recent data also shows that the HAS-BLED score also outperforms other scores (both new and old ones) in predicting bleeding risk."

These new findings support the moves in the 2010 ESC Guidelines for the management of atrial fibrillation to introduce the HAS-BLED bleeding score, and to shift away from the traditional low/moderate/high risk artificial categorisation of stroke risk, and moving towards a risk factor based approach to stroke prevention in atrial fibrillation using the CHA2DS2-VASc score.

Novel data has also been published on the new oral anticoagulants for stroke prevention in atrial fibrillation. In a recent modelling analysis, the researchers used the scores for stroke risk and bleeding to calculate the net clinical benefit of the new anticoagulants. They found that when the risk of bleeding and stroke were both high, the new oral anticoagulants appeared to have a much greater net clinical benefit compared to warfarin (4).

"Since 2010 there have many new trials related to the new anticoagulants and therefore this is a very exciting time for stroke prevention," says Professor Lip. "These new drugs are powerful anticoagulants. They work well if they are used correctly and in the appropriate patients."

These new findings in this fast changing field are paving the way for the launch of a Focused Update to the ESC Guidelines on atrial fibrillation at the ESC Congress in August in Munich, Germany.

Cardiostim is expected to attract more than 5,000 delegates from across the globe with an interest in electrophysiology. Future events in this field include EHRA EUROPACE 2013, which will be held 23-26 June 2013 in Athens, Greece. This conference is EHRA's official meeting and for the first time in 2013 it will be held jointly with the ESC Working Group on Cardiac Cellular Electrophysiology and the ESC Working Group on e-Cardiology. This unique partnership emphasises the multidisciplinary and translational approach in modern electrophysiology in the diagnosis and therapy of arrhythmias and conduction disturbance.
-end-


European Society of Cardiology

Related Stroke Articles from Brightsurf:

Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care
An interactive, digital alarm clock may speed emergency stroke care, starting at hospital arrival and through each step of the time-sensitive treatment process.

Stroke patients with COVID-19 have increased inflammation, stroke severity and death
Stroke patients who also have COVID-19 showed increased systemic inflammation, a more serious stroke severity and a much higher rate of death, compared to stroke patients who did not have COVID-19, according a retrospective, observational, cross-sectional study of 60 ischemic stroke patients admitted to UAB Hospital between late March and early May 2020.

'Time is vision' after a stroke
University of Rochester researchers studied stroke patients who experienced vision loss and found that the patients retained some visual abilities immediately after the stroke but these abilities diminished gradually and eventually disappeared permanently after approximately six months.

More stroke awareness, better eating habits may help reduce stroke risk for young adult African-Americans
Young African-Americans are experiencing higher rates of stroke because of health conditions such as high blood pressure, diabetes and obesity, yet their perception of their stroke risk is low.

How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.

Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.

High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.

Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.

We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.

Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.

Read More: Stroke News and Stroke Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.