Stroke Risk identification and Risk Stratification


<< Stroke risk FactorsReferences >>


Identifying risk factors is crucial in both Primary and Secondary Prevention of Stroke.Established/Well Documented Risk Factors Global include:

Non-modifiable: Male gender, Age, Race, Family history.

Modifiable risk factors include: Arterial hypertension, Diabetes mellitus, Cigarette smoking, Hyper-lipidaemia, Asymptomatic carotid disease, Atrial Fibrillation.

A local Kenyan study found established/well documented risk factors as: Hypertension-80%. Diabetes-mellitus- 33.7%, both-Hypertension and Diabetes-mellitus-28.8% (with 85% being poorly controlled for hypertension and or diabetes mellitus at time of admission to hospital) .Miscellaneous list included atrial fibrillation and carotid disease.

Less well-documented risk factors included Hyper-homocysteinemia and HIV/Aids.

Can one predict risk of stroke after a TIA? Yes.  The ABCD2 score is validated tool that can be used to prect risk of stroke occurrence in patients presenting with TIA.

Unified ABCD2 risk score

A Age (years)

60 = 1 point

<60 = 0 point

B Blood pressure

Systolic>140 &/or Diastolic 90 =1 point

Systolic140 &/or Diastolic <90 =0 point

C Clinical features

Unilateral weakness =2 points

Speech disturbance without weakness =1 point

Other =0 point

D Duration of symptoms [in minutes]

60 = 2 points

10-59 = 1 point

<10 = 0 point

D Diabetes If present = 1 point


ABCD2 SCORE Interpretation:


0-3 LOW RISK (can be managed as an outpatient)

4-5 MODERATE RISK- (Admit to hospital and be aggressive with investigation and




Stroke & atrial fibrillation:

Atrial fibrillation (AF) increases stroke risk 5-fold, 15% of all ischemic stroke patients have AF.[similar

figure found at local Kenyan study]. Women have atrial fibrillation related stroke more than men. AF patients with stroke have increased mortality and morbidity [majorly due to recurrence]

Can one predict risk of stroke in a patient with atrial fibrillation? YES.

CHADS2 score is validated scoring tool to predict the risk of stroke occurrence in patients with atrial fibrillation.


Clinical parameter                                                                score

Congestive heart failure                                                          1

Hypertension                                                                             1

Age >75                                                                                     1

Diabetes mellitus                                                                     1

Stroke or TIA                                                                              2


CHADS2 Score interpretation:

Scale goes from 0-6

Score 0: baseline risk is so small

Score of 1: think about anti-coagulating, but maybe aspirin is an appropriate medication.

Most Guidelines say that CHADS2 score of 2 or greater: seriously think of anticoagulation. Warfarin remains the standard of care. However, there are new anticoagulants which may not require frequent monitoring  but are more expensive comapred to warfarin. These include Dabigatran, Rivaroxaban and apixaban.


CHA2DS2VASC score.

Includes vascular disease e.g. those with MI and or Peripheral arterial disease, thromboembolism and gender (female) as well. It lowers the threshold for anticoagulation.

Clinical parameter                                                                score

Congestive heart failureLeft ventricular dysfunction         1

Hypertension                                                                           1

Age >75                                                                                    2

Diabetes mellitus                                                                   1

Vascular disease                                                                   1

Age  65-75( in those with vascular disease)                    1

Stroke or TIA                                                                            2

Sex (female)                                                                           1



The interpretation as similar to CHADS2 Scoreinterpretation above.


<< Stroke risk FactorsReferences >>


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Release date: 25-08-2013
Expiry date: 25-08-2014