Meta-Analysis of CHADS2 versus CHA2DS2-VASc for Predicting Stroke and Thromboembolism in Atrial Fibrillation Patients Independent of Anticoagulation

<jats:p>Two validated scoring systems for predicting embolic risk, CHADS2 and CHA2DS2-VASc, contribute to optimizing antithrombotic prescription practices in patients who have atrial fibrillation. However, data about anticoagulated patients are sparse. We compared CHADS2 and CHA2DS2-VASc, in terms of their predictive risk evaluation, in patients with atrial fibrillation who were and were not taking anticoagulants.</jats:p> <jats:p>We systematically searched the Cochrane Library, PubMed, and Embase databases for studies of the comparative diagnostic performance of CHADS2 and CHA2DS2-VASc. We identified 12 cohort studies for meta-analysis. With regard to the occurrence of cardiovascular events individually, patients with CHA2DS2-VASc scores ≥2 have a greater risk of stroke (risk ratio [RR]=5.15; 95% confidence interval [CI], 3.85–6.88; P &lt;0.00001) and thromboembolism (RR=5.96; 95% CI, 5.50–6.45; P &lt;0.00001) (Pdiff=0.34) than do patients with CHA2DS2-VASc scores &lt;2, independent of anticoagulation therapy (RR=5.76; 95% CI, 5.23–6.35; P &lt;0.00001 in anticoagulated patients; and RR=6.12; 95% CI, 5.40–6.93; P &lt;0.00001 in patients not taking anticoagulants; Pdiff=0.45). The pooled RR estimates indicate an approximate 6-fold increase in the risk of endpoint events in patients with CHA2DS2-VASc scores ≥2 (RR=5.90; 95% CI, 5.46–6.37; P &lt;0.0001).</jats:p> <jats:p>These results clearly indicate the discriminative capacity of the CHA2DS2-VASc score for stroke, thromboembolic events, or both, independent of optimal anticoagulation. The CHA2DS2-VASc score enables the identification of patients who are at genuinely high risk and can direct the selection of appropriate therapeutic approaches.</jats:p>