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Thromb Haemost 2021; 121(08): 1107-1114
DOI: 10.1055/a-1333-4448
Stroke, Systemic or Venous Thromboembolism

Stroke and Thromboembolism in Warfarin-Treated Patients with Atrial Fibrillation: Comparing the CHA2DS2-VASc and GARFIELD-AF Risk Scores

Marco Proietti    *
1   Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
2   Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
3   Geriatric Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
,
José Miguel Rivera-Caravaca  ‡   *
4   Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBER-CV, Murcia, Spain
,
María Asunción Esteve-Pastor 
4   Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBER-CV, Murcia, Spain
,
Francísco Marín
4   Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBER-CV, Murcia, Spain
,
Gregory Y. H. Lip    **
1   Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
5   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
› Author Affiliations Funding No funding has been received in the preparation of this manuscript. Astra Zeneca provided datasets for the analysis. Astra Zeneca was never involved in any stage of manuscript drafting and preparation.
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Abstract

Background Evaluation of thromboembolic risk is essential in anticoagulated atrial fibrillation (AF) patients. The CHA2DS2-VASc score is largely validated and recommended by most guidelines. The GARFIELD-AF Stroke score has been proposed as an alternative risk score.

Methods We analyzed warfarin-treated patients from SPORTIF III and V studies. Any thromboembolic event (TE) was an adjudicated study outcome. We compared the two scores' capacity in predicting any TE occurrence.

Results 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 CHA2DS2-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. CHA2DS2-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, CHA2DS2-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, CHA2DS2-VASc was associated with improved clinical usefulness and net clinical benefit, compared with GARFIELD-AF.

Conclusion In a warfarin-treated trial cohort of AF patients, both CHA2DS2-VASc and GARFIELD-AF Stroke scores were associated with adjudicated TE events, with modest predictive capacity. The simpler CHA2DS2-VASc score improved discriminatory capacity compared with the more complex GARFIELD-AF score, demonstrating improved clinical usefulness and net clinical benefit.

Keywords

atrial fibrillation - risk scores - thromboembolic events

* Both authors equally contributed to the manuscript.


** The editorial process for this paper article was fully handled by Prof. Christian Weber, Editor-in-Chief.


Supplementary Material



Publication History

Received: 23 September 2020

Accepted: 04 December 2020

Accepted Manuscript online:
09 December 2020

Article published online:
26 January 2021

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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