Clinical Interventions in Aging (Oct 2023)
Future Perspectives to Improve CHA2DS2VASc Score: The Role of Left Atrium Remodelling, Inflammation and Genetics in Anticoagulation of Atrial Fibrillation
Abstract
Ciprian Rachieru,1– 3 Constantin-Tudor Luca,4– 6 Cristina Văcărescu,4– 6 Lucian Petrescu,4 Liviu Cirin,4 Dragos Cozma4– 6 1Faculty of Medicine, Department of Internal Medicine I, Discipline of Medical Semiology I “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania; 2Internal Medicine Department, County Emergency Hospital, Timisoara, 300079, Romania; 3Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania; 4Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, Timisoara, 300041, Romania; 5Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, Romania; 6Research Center of the Institute of Cardiovascular Diseases Timisoara, Timisoara, 300310, RomaniaCorrespondence: Cristina Văcărescu, Cardiology Department, Institute of Cardiovascular Diseases, 13A Gheorghe Adam Street, Timișoara, 300310, Romania, Tel +40 722 956 370, Fax +40 256 207 362, Email [email protected]: In 10% of ischemic strokes, non-valvular atrial fibrillation (NVAF) is detected retroactively. Milder, or even asymptomatic forms of NVAF have shown high mortality, thrombotic risk, and deterioration of cognitive function. The current guidelines for the diagnosis and treatment of AF contain “grey areas”, such as the one related to anticoagulant treatment in men with CHA2DS2-VASc score 1 and women with score 2. Moreover, parameters such as renal function, patient weight or left atrium remodelling are missing from the recommended guidelines scores. Vulnerable categories of patients including the elderly population, high hemorrhagic risk patients or patients with newly diagnosed paroxysmal episodes of atrial high rate at device interrogation are at risk of underestimation of the thrombotic risk. This review presents a systematic exposure of the most important gaps in evaluation of thrombotic and hemorrhagic risk in patients with NVAF. The authors propose new algorithms and risk factors that should be taken into consideration for an accurate thrombotic and hemorrhagic risk estimation, especially in vulnerable categories of patients.Keywords: atrial fibrillation, thrombotic risk, hemorrhagic risk, new risk scores, left atrium remodelling, genetics and inflammation in atrial fibrillation
