Anticoagulation, CHA2DS2VASc Score, and Thromboembolic Risk of Cardioversion of Acute Atrial Fibrillation (from the FinCV Study).

Published on Apr 1, 2016in American Journal of Cardiology2.843
· DOI :10.1016/j.amjcard.2016.01.024
Toni Grönberg1
Estimated H-index: 1
(UTU: University of Turku),
Juha Hartikainen37
Estimated H-index: 37
+ 3 AuthorsK.E. Juhani Airaksinen30
Estimated H-index: 30
(TYKS: Turku University Hospital)
The efficacy of the anticoagulation in preventing thromboembolic complications (TEC) and the usefulness of the CHA 2 DS 2 VASc score for assessing stroke risk during cardioversion of acute atrial fibrillation (AF) are unclear. Thus, our objectives were to assess the ability of the CHA 2 DS 2 VASc score to predict TEC and to evaluate the efficacy of anticoagulation in the prevention of TEC in Finnish CardioVersion (FinCV) study. The FinCV is a retrospective, multicenter study of 3,143 patients, who underwent 7,660 cardioversions for acute AF. The value of the CHA 2 DS 2 VASc score in predicting TEC was analyzed separately in cardioversions performed without and with anticoagulation. A total of 40 definite TEC (0.6%) occurred after 7,237 successful cardioversions and 1 stroke (0.2%) after 423 unsuccessful procedures. In 5,362 cardioversions performed without anticoagulation, the risk of definite TEC increased significantly from 0.4% in patients with a CHA 2 DS 2 VASc score of 0 to 1 to 2.3% in those with score of ≥5 (p 2 DS 2 VASc score was 0.72 (0.61 to 0.83) in predicting definite TEC in non-anticoagulated patients with first cardioversion. The incidence of definite TEC was significantly lower in 2,298 cardioversions performed during anticoagulation (0.1% vs 0.7%, p = 0.001), and the preventive effect of anticoagulation was significant in patients with a score of ≥2 (0.2% vs 1.1%, p = 0.001). In conclusion, CHA 2 DS 2 VASc score is a strong predictor of TEC in cardioversion of acute AF performed without anticoagulation. Importantly, periprocedural anticoagulation reduced the risk of TEC by 82%. The overall risk of these complications was low after failed cardioversion.
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