Key result
CHA2DS2-VASc score ≥4 is linked to ~4.6-fold higher ischemic stroke risk in hemodialysis patients.
Why the study?
The predictive value of CHA2DS2-VASc and HAS-BLED scores for cerebrovascular events and hemorrhage remains controversial in the dialysis population.
Do the CHA2DS2-VASc and HAS-BLED scores predict stroke and bleeding events in hemodialysis patients?
Cohort (n=256)
Yes
Do the CHA2DS2-VASc and HAS-BLED scores predict stroke and bleeding events in hemodialysis patients?
Odds Ratio: 4.56 (95% CI 1.31–15.85)
p-value: p=0.017
The CHA2DS2-VASc and HAS-BLED scores are significantly associated with stroke and bleeding events respectively in hemodialysis patients, with a cutoff of ≥4 identifying those at highest risk.
CHA2DS2-VASc ≥4 may flag higher ischemic stroke risk in hemodialysis; leaves open prospective validation before guiding anticoagulation.
Background In the general population, the CHA2DS2-VASC and the HAS-BLED scores are helpful to predict cerebrovascular events and hemorrhage in patients with atrial fibrillation (AF). However, their predictive value remains controversial in the dialysis population. This study aims to explore the association between these scores and cerebral cardiovascular events in hemodialysis (HD) patients. Methods This is a retrospective study including all HD patients treated between January 2010 and December 2019 in two Lebanese dialysis facilities. Exclusion criteria are patients younger than 18 years old and patients with a dialysis vintage less than 6 months. Results A total of 256 patients were included (66.8% men; mean age 69.3 ± 13.9 years). The CHA2DS2-VASc score was significantly higher in patients with stroke (P = .043). Interestingly, this difference was significant in patients without AF (P = .017). Using receiver operating curve analysis, CHA2DS2-VASc score had an area under the curve (AUC) of 0.628 [95% confidence interval (CI): 0.539–0.718) and the best cut-off value for this score was 4. The HAS-BLED score was also significantly higher in patients with a hemorrhagic event (P < .001). AUC for HAS-BLED score was 0.756 (95% CI: 0.686–0.825) and the best cut-off value was also 4. Conclusions In HD patients, CHA2DS2-VASc score can be associated with stroke and HAS-BLED score can be associated with hemorrhagic events even in patients without AF. Patients with a CHA2DS2-VASc score ≥4 are at the highest risk for stroke and adverse cardiovascular outcomes, and those with a HAS-BLED score ≥4 are at the highest risk for bleeding.
No takes yet. Share an insight, caveat, or question.
Sab et al. (2022) conducted a cohort in Hemodialysis patients (n=256). CHA2DS2-VASc score ≥4 vs. CHA2DS2-VASc score <4 was evaluated on Ischemic stroke or transient ischemic attack (OR 4.56, 95% CI 1.31-15.85, p=0.017). In hemodialysis patients, a CHA2DS2-VASc score ≥4 was associated with a significantly increased risk of ischemic stroke (OR 4.56).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: