CHADS₂ and CHA₂DS₂-VASc Scores Can Guide the Evaluation of Cryptogenic Ischemic Stroke

Background and aims: Cryptogenic ischemic strokes (CIS) are treated with antiplatelets for stroke prevention in routine clinical practice. The objective of this study was to investigate whether the CHADS₂ and CHA₂DS₂-VASc scores may be used to identify the patients with CIS at higher risk of ischemic stroke despite antiplatelet therapy.

Material and methods: We calculated CHADS₂ and CHA₂DS₂-VASc scores in patients with first ever CIS; those previously managed with antiplatelets (AP group) and in those without antiplatelets (non-AP group), using the prospectively recorded data of the Istanbul Medical School Stroke Registry from 1996-2014.

Results: Of the 4466 IS patients, 886 patients with first ever IS had complete data for score calculation. Seventy-five (39 women) of them were diagnosed with CIS. CHADS₂ and CHA₂DS₂-VASc scores were significantly higher in the AP group of 19 patients in comparison to the non-AP group of 56 patients (P = 0.005 and P = 0.009, respectively). ROC curve analyses showed an area under curve (AUC) of 0.705 (CI: 0.57-0.84; P = 0.008) for CHADS₂ score ≥3 and AUC of 0.699 (CI: 0.57-0.82; P = 0.01) for CHA₂DS₂-VASc score ≥4. Vascular diseases were more frequent in the AP group and these patients were older than the patients in the non-AP group (P = 0.025, P = 0.024; respectively).

Conclusions: CHA₂DS₂-VASc score ≥ 4 and CHADS₂ score ≥3 may be used as a predictor of the occurrence of IS despite regular antiplatelet use and suggest an embolic source which will respond better to anticogulation. Our results support that CHADS₂ and CHA₂DS₂-VASc scores may be useful to identify subgroups among patients with CIS for individualizing diagnostic approach, planning future workup and preventive treatment.