Update in office managementImplications of the CHA2DS2-VASc and HAS-BLED Scores for Thromboprophylaxis in Atrial Fibrillation
Section snippets
How Can We Assess Bleeding Risk?
Many risk factors for stroke are also risk factors for bleeding.7 Furthermore, previously published schemes for bleeding risk stratification (Table 2) by Shireman et al,8 Gage et al9 (with the acronym HEMORR2HAGES), Beyth et al,10 and Kuijer et al11 have been difficult to apply in routine clinical practice, with some being based on complex scoring systems,9, 11 and only one scheme having been formally derived (and then validated) in an atrial fibrillation cohort.9 A lack of consensus and
How Would a Simple, Easy Score in Assessing Bleeding Risk Help Office Management of Atrial Fibrillation Patients?
Recent data have shown that even in “moderate risk” patients (ie, CHADS2 score = 1), oral anticoagulation is superior to aspirin for stroke and mortality prevention,13 and among “low risk” atrial fibrillation patients (ie, CHADS2 score = 0), aspirin may be no better than control for the reduction of thromboembolism, with a risk of increased bleeding.14 When aspirin alone was compared with placebo or no treatment in 7 trials, a meta-analysis showed that aspirin was associated with a non-significant
How Would the HAS-BLED Score Help Office Management with Future Developments in Thromboprophylaxis for Atrial Fibrillation?
The landscape has recently changed with new oral anticoagulants that avoid some of the limitations and disadvantages of warfarin. In the RE-LY (Randomized Evaluation of Long-term anticoagulant therapY) trial, for example, dabigatran 100 mg twice daily was noninferior to warfarin for stroke prevention, with 20% less major bleeding events; while dabigatran 150 mg twice daily was superior in efficacy for stroke prevention compared with warfarin, with a similar rate of major bleeds.18 The
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2020, World NeurosurgeryCitation Excerpt :The relative risk of thromboembolic events is high; however, the absolute risk remains very low, at a rate of 1–2 events per 100 patient-years. For example, if anticoagulation is held for 5 days preoperatively and 7 days postoperatively, the 12-day risk of a cerebral ischemic event is 1.0%, assuming a daily rate of 0.033% according to the CHA2DS2-VASc and a 2.5 times increase in hypercoagulability associated with perioperative holding of anticoagulation.4,14 This risk is balanced against the potentially fatal risk of an IPH.
Funding: None.
Conflict of Interest: Dr. Lip has received funding for research, educational symposia, consultancy, and lecturing from different manufacturers of drugs used for the treatment of atrial fibrillation and thrombosis.
Authorship: The author had a full role in writing the manuscript.