The impact of CHADS2 score on late stroke after the Cox maze procedure
Mitchell Pet, Jason O. Robertson, Marci Bailey, Tracey J. Guthrie, Marc R. Moon, Jennifer S. Lawton, Andrew Rinne, Ralph J. Damiano, Hersh S. Maniar
Objective: The Heart Rhythm Society, European Heart Rhythm Association, and European Cardiac Arrhythmia Society jointly recommend indefinite warfarin anticoagulation in patients with CHADS2 (congestive heart failure, hypertension, age, diabetes, and stroke) score of at least 2 who have undergone ablation for atrial fibrillation. This study determined the impact of CHADS 2 score on risk of late stroke or transient ischemic attack after the performance of a surgical Cox maze procedure. Methods: A retrospective review of 433 patients who underwent a Cox maze procedure at our institution was conducted. Three months after surgery, warfarin was discontinued regardless of CHADS2 score if the patient showed no evidence of atrial fibrillation, was off antiarrhythmic medications, and had no other indication for anticoagulation. A follow-up questionnaire was used to determine whether any neurologic event had occurred since surgery. Results: Follow-up was obtained for 90% of the study group (389/433) at a mean of 6.6 ± 5.0 years. Among these patients, 32% (125/389) had a CHADS2 score of at least 2, of whom only 40% (51/125) remained on long-term warfarin after surgery. Six patients had late neurologic events (annualized risk of 0.2%). Neither CHADS2 score nor warfarin anticoagulation was significantly associated with the occurrence of late neurologic events. Among the individual CHADS2 criteria, both diabetes mellitus and previous stroke or transient ischemic attack were predictive of late neurologic events. Conclusions: The risk of stroke or transient ischemic attack in patients after a surgical Cox maze procedure was low and not associated with CHADS2 score or warfarin use. Given the known risks of warfarin, we recommend discontinuation of anticoagulation 3 months after the procedure if the patient has no evidence of atrial fibrillation, has discontinued antiarrhythmic medications, and is without any other indication for systemic anticoagulation.
Journal of Thoracic and Cardiovascular Surgery
https://doi.org/10.1016/j.jtcvs.2012.03.087
Pulmonary and Respiratory Medicine
10.1016/j.jtcvs.2012.03.087
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Warfarin Medicine & Life Sciences
Transient Ischemic Attack Medicine & Life Sciences
Nervous System Medicine & Life Sciences
Atrial Fibrillation Medicine & Life Sciences
Cardiac Arrhythmias Medicine & Life Sciences
Pet, M., Robertson, J. O., Bailey, M., Guthrie, T. J., Moon, M. R., Lawton, J. S., Rinne, A., Damiano, R. J., & Maniar, H. S. (2013). The impact of CHADS2 score on late stroke after the Cox maze procedure. Journal of Thoracic and Cardiovascular Surgery, 146(1), 85-89. https://doi.org/10.1016/j.jtcvs.2012.03.087
The impact of CHADS2 score on late stroke after the Cox maze procedure. / Pet, Mitchell; Robertson, Jason O.; Bailey, Marci; Guthrie, Tracey J.; Moon, Marc R.; Lawton, Jennifer S.; Rinne, Andrew; Damiano, Ralph J.; Maniar, Hersh S.
In: Journal of Thoracic and Cardiovascular Surgery, Vol. 146, No. 1, 07.2013, p. 85-89.
Pet, M, Robertson, JO, Bailey, M, Guthrie, TJ, Moon, MR, Lawton, JS, Rinne, A, Damiano, RJ & Maniar, HS 2013, 'The impact of CHADS2 score on late stroke after the Cox maze procedure', Journal of Thoracic and Cardiovascular Surgery, vol. 146, no. 1, pp. 85-89. https://doi.org/10.1016/j.jtcvs.2012.03.087
Pet M, Robertson JO, Bailey M, Guthrie TJ, Moon MR, Lawton JS et al. The impact of CHADS2 score on late stroke after the Cox maze procedure. Journal of Thoracic and Cardiovascular Surgery. 2013 Jul;146(1):85-89. https://doi.org/10.1016/j.jtcvs.2012.03.087
Pet, Mitchell ; Robertson, Jason O. ; Bailey, Marci ; Guthrie, Tracey J. ; Moon, Marc R. ; Lawton, Jennifer S. ; Rinne, Andrew ; Damiano, Ralph J. ; Maniar, Hersh S. / The impact of CHADS2 score on late stroke after the Cox maze procedure. In: Journal of Thoracic and Cardiovascular Surgery. 2013 ; Vol. 146, No. 1. pp. 85-89.
@article{7039e5a4122f49d99c379f4a4307c529,
title = "The impact of CHADS2 score on late stroke after the Cox maze procedure",
abstract = "Objective: The Heart Rhythm Society, European Heart Rhythm Association, and European Cardiac Arrhythmia Society jointly recommend indefinite warfarin anticoagulation in patients with CHADS2 (congestive heart failure, hypertension, age, diabetes, and stroke) score of at least 2 who have undergone ablation for atrial fibrillation. This study determined the impact of CHADS 2 score on risk of late stroke or transient ischemic attack after the performance of a surgical Cox maze procedure. Methods: A retrospective review of 433 patients who underwent a Cox maze procedure at our institution was conducted. Three months after surgery, warfarin was discontinued regardless of CHADS2 score if the patient showed no evidence of atrial fibrillation, was off antiarrhythmic medications, and had no other indication for anticoagulation. A follow-up questionnaire was used to determine whether any neurologic event had occurred since surgery. Results: Follow-up was obtained for 90% of the study group (389/433) at a mean of 6.6 ± 5.0 years. Among these patients, 32% (125/389) had a CHADS2 score of at least 2, of whom only 40% (51/125) remained on long-term warfarin after surgery. Six patients had late neurologic events (annualized risk of 0.2%). Neither CHADS2 score nor warfarin anticoagulation was significantly associated with the occurrence of late neurologic events. Among the individual CHADS2 criteria, both diabetes mellitus and previous stroke or transient ischemic attack were predictive of late neurologic events. Conclusions: The risk of stroke or transient ischemic attack in patients after a surgical Cox maze procedure was low and not associated with CHADS2 score or warfarin use. Given the known risks of warfarin, we recommend discontinuation of anticoagulation 3 months after the procedure if the patient has no evidence of atrial fibrillation, has discontinued antiarrhythmic medications, and is without any other indication for systemic anticoagulation.",
author = "Mitchell Pet and Robertson, {Jason O.} and Marci Bailey and Guthrie, {Tracey J.} and Moon, {Marc R.} and Lawton, {Jennifer S.} and Andrew Rinne and Damiano, {Ralph J.} and Maniar, {Hersh S.}",
doi = "10.1016/j.jtcvs.2012.03.087",
journal = "Journal of Thoracic and Cardiovascular Surgery",
T1 - The impact of CHADS2 score on late stroke after the Cox maze procedure
AU - Pet, Mitchell
AU - Robertson, Jason O.
AU - Bailey, Marci
AU - Guthrie, Tracey J.
AU - Moon, Marc R.
AU - Lawton, Jennifer S.
AU - Rinne, Andrew
AU - Damiano, Ralph J.
AU - Maniar, Hersh S.
N2 - Objective: The Heart Rhythm Society, European Heart Rhythm Association, and European Cardiac Arrhythmia Society jointly recommend indefinite warfarin anticoagulation in patients with CHADS2 (congestive heart failure, hypertension, age, diabetes, and stroke) score of at least 2 who have undergone ablation for atrial fibrillation. This study determined the impact of CHADS 2 score on risk of late stroke or transient ischemic attack after the performance of a surgical Cox maze procedure. Methods: A retrospective review of 433 patients who underwent a Cox maze procedure at our institution was conducted. Three months after surgery, warfarin was discontinued regardless of CHADS2 score if the patient showed no evidence of atrial fibrillation, was off antiarrhythmic medications, and had no other indication for anticoagulation. A follow-up questionnaire was used to determine whether any neurologic event had occurred since surgery. Results: Follow-up was obtained for 90% of the study group (389/433) at a mean of 6.6 ± 5.0 years. Among these patients, 32% (125/389) had a CHADS2 score of at least 2, of whom only 40% (51/125) remained on long-term warfarin after surgery. Six patients had late neurologic events (annualized risk of 0.2%). Neither CHADS2 score nor warfarin anticoagulation was significantly associated with the occurrence of late neurologic events. Among the individual CHADS2 criteria, both diabetes mellitus and previous stroke or transient ischemic attack were predictive of late neurologic events. Conclusions: The risk of stroke or transient ischemic attack in patients after a surgical Cox maze procedure was low and not associated with CHADS2 score or warfarin use. Given the known risks of warfarin, we recommend discontinuation of anticoagulation 3 months after the procedure if the patient has no evidence of atrial fibrillation, has discontinued antiarrhythmic medications, and is without any other indication for systemic anticoagulation.
AB - Objective: The Heart Rhythm Society, European Heart Rhythm Association, and European Cardiac Arrhythmia Society jointly recommend indefinite warfarin anticoagulation in patients with CHADS2 (congestive heart failure, hypertension, age, diabetes, and stroke) score of at least 2 who have undergone ablation for atrial fibrillation. This study determined the impact of CHADS 2 score on risk of late stroke or transient ischemic attack after the performance of a surgical Cox maze procedure. Methods: A retrospective review of 433 patients who underwent a Cox maze procedure at our institution was conducted. Three months after surgery, warfarin was discontinued regardless of CHADS2 score if the patient showed no evidence of atrial fibrillation, was off antiarrhythmic medications, and had no other indication for anticoagulation. A follow-up questionnaire was used to determine whether any neurologic event had occurred since surgery. Results: Follow-up was obtained for 90% of the study group (389/433) at a mean of 6.6 ± 5.0 years. Among these patients, 32% (125/389) had a CHADS2 score of at least 2, of whom only 40% (51/125) remained on long-term warfarin after surgery. Six patients had late neurologic events (annualized risk of 0.2%). Neither CHADS2 score nor warfarin anticoagulation was significantly associated with the occurrence of late neurologic events. Among the individual CHADS2 criteria, both diabetes mellitus and previous stroke or transient ischemic attack were predictive of late neurologic events. Conclusions: The risk of stroke or transient ischemic attack in patients after a surgical Cox maze procedure was low and not associated with CHADS2 score or warfarin use. Given the known risks of warfarin, we recommend discontinuation of anticoagulation 3 months after the procedure if the patient has no evidence of atrial fibrillation, has discontinued antiarrhythmic medications, and is without any other indication for systemic anticoagulation.
U2 - 10.1016/j.jtcvs.2012.03.087
DO - 10.1016/j.jtcvs.2012.03.087
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery