Atrial Fibrillation - What Is Your Risk For Stroke?
Today I will be discussing one of the most important features when managing atrial fibrillation, which is determining a patient’s risk of stroke. So how does your doctor decide what is your individual risk of stroke?
The most commonly used scoring system is called the CHADSVASc risk score. Each one of the initials in the CHADSVASc risk score stands for a risk factor, which can then increase your risk of stroke. Depending on the risk factor, you either get one or two points to get the overall score and determine a patient’s risk of stroke.
So let's break down the term. First, C, stands for congestive heart failure, or CHF. If you have this condition you get one point. H, stands for hypertension, or high blood pressure. If you have high blood pressure, even if it's well controlled on medications, you get one point. A, is for age 75 or greater. If your age is over 75 then you have a significantly increased risk of stroke, and you get two points. D, is for diabetes. Even if a patient’s diabetes is well controlled on medications or diet you get one point. S, stands for pass history for stroke. If you've had a stroke in the past, or even a mini stroke or TIA, you get two points. If a patient has had one stroke or mini-stroke in the past then the risk of a future additional stroke is significantly increased.
Continuing, V, stands for vascular disease, which can stand for blockages in arteries of your legs, or your neck, or in your heart as well. So if you've had a past heart attack or have stents inside of your heart, you get one point. The second A, stands for age 65 to 74, which if you're in this age range you also get one point. And the Sc, stands for sex category. If you're female you get one additional point.
So to get your CHADSVASc risk score you add up all your points to get your total score. So what do these numbers mean? This is how your doctor most commonly decides what is your overall risk of stroke.
If you have a risk score of zero to one, you're overall considered a low stroke risk and using blood stronger thinners is considered optional. But once you reach a CHADSVASc score of two or greater if you are male, or three or greater if you are female, your overall risk of stroke is significant enough that it is typically recommended to use strong blood thinners called anticoagulation. As per the 2019 Guideline Update on the Management of Patients with Atrial Fibrillation, using an aspirin for stroke risk reduction is no longer recommend. Based on available data, if we start at a CHADSVASc risk score of two, a patient’s annual risk of stroke is 2.2% and can go all the way up to 15% for patients who have the highest risk for stroke.
Fortunately, there are several blood-thinning medication options these days in order to help reduce a patient’s risk of stroke. When starting someone on blood thinners, many factors need to be considered. Risk of stroke is very important, but other factors that needed to be considered are bleeding risks and patient preferences. In addition there are several procedures for left atrial appendage occlusion, which are also available to help reduce risk of stroke for patients that are unable to tolerate blood-thinning medications.
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