Prior ischemic strokes are non-inferior for predicting future ischemic strokes than CHA(2)DS(2)-VASc score in hemodialysis patients with non-valvular atrial fibrillation

BACKGROUND: We tested whether CHA(2)DS(2)-VASc and/or HAS-BLED scores better predict ischemic stroke and major bleeding, respectively, than their individual components in maintenance hemodialysis (MHD) patients with atrial fibrillation (AF). METHODS: A retrospective cohort study of a clinical database containing the medical records of 268 MHD patients with non-valvular AF (167 women, mean age 73.4 ± 10.2 years). During the median follow-up of 21.0 (interquartile range, 5.0–44.0) months, 46 (17.2%) ischemic strokes and 24 (9.0%) major bleeding events were reported. RESULTS: Although CHA(2)DS(2)-VASc predicted ischemic stroke risk in the study population (adjusted HR 1.74 with 95% CI 1.23–2.46 for each unit of increase in CHA(2)DS(2)-VASc score, and HR of 5.57 with 95% CI 1.88–16.49 for CHA(2)DS(2)-VASc score ≥ 6), prior ischemic strokes/transient ischemic attacks (TIAs) were non-inferior in both univariate and multivariate analyses (adjusted HR 8.65 with 95% CI 2.82–26.49). The ROC AUC was larger for the prior ischemic stroke/TIA than for CHA(2)DS(2)-VASc. Furthermore, the CHA(2)DS(2)-VASc score did not predict future ischemic stroke risks in study participants who did not previously experience ischemic strokes/TIAs (adjusted HR 1.41, 95% CI: 0.84–2.36). The HAS-BLED score and its components did not have predictive abilities in discriminating bleeding risk in the study population. CONCLUSIONS: Previous ischemic strokes are non-inferior for predicting of future ischemic strokes than the complete CHA(2)DS(2)-VASc score in MHD patients. CHA(2)DS(2)VASc scores are less predictive in MHD patients without histories of CVA/TIA. HAS-BLED scores do not predict major bleeding in MHD patients. These findings should redesign approaches to ischemic stroke risk stratification in MHD patients if future large-scale epidemiological studies confirm them.