An evidence-based approach to stroke prevention: important advances in the last decade.

From this study and another in the United Kingdom, the ABCD2 score was developed [Age greater than 60 (one point), Blood pressure 140/90 mmHg or greater (one point), clinical feature of unilateral weakness (two points) or speech impairment without weakness (one point), Duration greater than 60 minutes (two points) or ten to 59 minutes (one point), and Diabetes (one point)]. Scores greater than four are associated with the greatest risk of recurrence. Both the SOS-TIA study 4 conducted in France and the EXPRESS study 5 conducted in the UK showed an 80% reduction in expected stroke risk with rapid evaluation (e.g. carotid imaging, telemetry within 24 hours) and treatment (carotid stenosis repair, warfarin for atrial fibrillation within a few days, statins for elevated LDL). atrIal fIbrIllatIon CHADS2 is a six-point score (range zero to six) in patients with atrial fibril-lation with points assigned as follows: Congestive heart failure (one point), Hypertension (one point), Age greater or equal to 75 years (one point), Diabetes mellitus (one point), previous Stroke/ transient ischemic attack (two points). Higher scores are associated with greater risk for stroke. Anticoagulation is generally recommended for a score of greater than two and no anticoagulation is recommended for a score of zero. Uncertainty exists about anticoagulation of patients with a score of one. The CHA2DS2VASc score was developed to help distinguish those with higher versus lower risk in the CHADS2 category of zero to one. The scores range from zero to nine with the following point assignment: [Congestive heart failure (one point), Hypertension (one point), Age greater or equal to 75 years (two points), Diabetes mellitus (one point), previous Stroke or transient ischemic attack (two points), Vascular disease i.e. CAD (one point), Age 65-74 years (one point), Sex category (one point for female gender). A CHA2DS2VASc score of zero to one predicts a lower risk of future stroke than dose a CHADS2 score of zero to one. Based on randomized trials, the risk of stroke following atrial fibrillation can be reduced by treatment with all of the following medications (approximate relative risk reductions noted with the caveat that there have been no direct trial comparisons between dabigatran, apixaban, and rivaroxaban): dabigatran 75%, apixaban 70%, rivaroxaban 60%, warfarin 60%, aspirin and clopidogrel 30%, and aspirin 20%. The absolute differences in clinical trials are as follows: dabigatran versus warfarin 1.11% per year versus 1.69% per year (ReLY trial), rivaroxaban versus warfarin …