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