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falabella bag stella mccartney For the intermediate risk category, guidelines recommend treatment with vitamin K antagonists or aspirin, and aspirin is recommended for the low risk category.Schemes for stratifying the risk of stroke have been largely derived from non anticoagulated arms of clinical trial cohorts, in which many potential thromboembolic risk factors were not recorded. In these historical trials, less than 10% of patients screened were randomised, and over the past 15 20 years the evolution of risk schemes has not improved their predictive value for patients at high risk.4 More recent data in patients at intermediate risk show that vitamin K antagonists are superior to aspirin in reducing the risk of thromboembolism and adverse events,5 6 7 and aspirin does not reduce the risk of thromboembolism in atrial fibrillation patients at «low risk».8 Thus, a paradigm shift has been proposed whereby greater efforts are made to identify «truly low risk» patients who may not need any antithrombotic treatment, whereas all others could be considered for oral anticoagulation.8 9 10The most commonly used scheme for stratifying the risk of stroke is the CHADS2 (Congestive heart failure, Hypertension, Age75 years, Diabetes mellitus, previous Stroke/transient ischaemic attack (doubled risk weight)) score.11 Various limitations of this score have been discussed, including classification of a large proportion of patients as being at «intermediate risk» and its omission of many potential thromboembolic risk factors.10 The 2006 ACC/AHA/ESC guideline listed these potential additional risk factors as being «less validated or weaker risk factors,» including female sex, age 65 74 years, coronary artery disease, and thyrotoxicosis.12 Since 2006, stronger evidence has accumulated that these additional risk factors (with the exception of thyrotoxicosis) should be considered in assessing thromboembolic risk and would be of value in identifying those patients at truly low risk.10 13 The additional risk factors have been expressed in the CHA2DS2 VASc (Congestive heart failure, Hypertension, Age75 years, Diabetes mellitus, previous Stroke/transient ischaemic attack, Vascular disease, Age 65 74 years, Sex category; age75 years and previous stroke carry doubled risk weight) score, which has been proposed to complement the CHADS2 score.13 In the original validation study from the EuroHeart survey, CHA2DS2 VASc generally had a similar C statistic to CHADS2 but was better at identifying the patients at truly low risk and categorised only a small proportion into the intermediate risk category.13 In a further study in a small elderly «real world» cohort with anticoagulated atrial fibrillation, the CHADS2 and CHA2DS2 VASc had similar strength (C statistics) for predicting thromboembolism.14An ideal validation cohort for a thromboembolic risk scheme would be a large real world cohort of patients with atrial fibrillation, without any use of anticoagulation treatment. In Denmark, the national patient registry allows such an analysis in a large cohort of real world patients, and the first objective of the analysis reported here was to assess the effects of the individual factors of CHADS2 and CHA2DS2 VASc on the risk of thromboembolism falabella bag stella mccartney.

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