Stroke and Thromboembolism in Warfarin-Treated Patients with Atrial Fibrillation: Comparing the CHA <sub>2</sub> DS <sub>2</sub> -VASc and GARFIELD-AF Risk Scores



Proietti, Marco ORCID: 0000-0003-1452-2478, Rivera-Caravaca, Jose Miguel ORCID: 0000-0003-0492-6241, Asuncion Esteve-Pastor, Maria, Marin, Francisco and Lip, Gregory YH ORCID: 0000-0002-7566-1626
(2021) Stroke and Thromboembolism in Warfarin-Treated Patients with Atrial Fibrillation: Comparing the CHA <sub>2</sub> DS <sub>2</sub> -VASc and GARFIELD-AF Risk Scores. THROMBOSIS AND HAEMOSTASIS, 121 (08). pp. 1107-1114.

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Abstract

<h4>Background</h4>Evaluation of thromboembolic risk is essential in anticoagulated atrial fibrillation (AF) patients. The CHA<sub>2</sub>DS<sub>2</sub>-VASc score is largely validated and recommended by most guidelines. The GARFIELD-AF Stroke score has been proposed as an alternative risk score.<h4>Methods</h4>We analyzed warfarin-treated patients from SPORTIF III and V studies. Any thromboembolic event (TE) was an <i>adjudicated</i> study outcome. We compared the two scores' capacity in predicting any TE occurrence.<h4>Results</h4>A total of 3,665 patients (median [interquartile range] age: 72 [66-77] years; 30.5% female) were included in this analysis. After a mean (standard deviation) follow-up of 566.3 (142.5) days, 148 (4.03%) TEs were recorded. Both continuous CHA<sub>2</sub>DS<sub>2</sub>-VASc and GARFIELD-AF were associated with TE (hazard ratio [HR]: 1.37, 95% confidence interval [CI]: 1.22-1.53 and HR: 2.43, 95% CI: 1.72-3.42), with modest predictive ability (c-indexes: 0.63, 95% CI: 0.59-0.68 and 0.61, 95% CI: 0.56-0.66, respectively), with no differences. CHA<sub>2</sub>DS<sub>2</sub>-VASc quartiles showed an increasing cumulative risk, while in GARFIELD-AF only the highest quartile (Q4) demonstrated an increased TE risk. On multivariate Cox regression analysis, CHA<sub>2</sub>DS<sub>2</sub>-VASc quartiles were associated with increasing risk of TE, whereas for GARFIELD-AF only Q4 showed an association with TE. Discrimination analysis showed that GARFIELD-AF quartiles were associated with a 48.7% reduction in discriminatory ability. Using decision curve analysis, CHA<sub>2</sub>DS<sub>2</sub>-VASc was associated with improved clinical usefulness and net clinical benefit, compared with GARFIELD-AF.<h4>Conclusion</h4>In a warfarin-treated trial cohort of AF patients, both CHA<sub>2</sub>DS<sub>2</sub>-VASc and GARFIELD-AF Stroke scores were associated with adjudicated TE events, with modest predictive capacity. The simpler CHA<sub>2</sub>DS<sub>2</sub>-VASc score improved discriminatory capacity compared with the more complex GARFIELD-AF score, demonstrating improved clinical usefulness and net clinical benefit.

Item Type: Article
Uncontrolled Keywords: atrial fibrillation, risk scores, thromboembolic events
Depositing User: Symplectic Admin
Date Deposited: 19 Feb 2021 16:30
Last Modified: 19 Oct 2023 15:52
DOI: 10.1055/a-1333-4448
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3115871