Stroke and Bleeding Risk in Atrial Fibrillation: Navigating the Alphabet Soup of Risk‐Score Acronyms (CHADS2, CHA2DS2‐VASc, R2CHADS2, HAS‐BLED, ATRIA, and More)

Dzeshka, Mikhail S.; Lane, Deirdre A.; Lip, Gregory Y. H.

doi:10.1002/clc.22294

Cited by 51 publications

(40 citation statements)

References 98 publications

(166 reference statements)

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“…For the purpose of reviewing warfarin utilization, we extracted only the high-risk group. We also calculated each patient's Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) score to estimate bleeding risk on warfarin [29,30]. ATRIA score is simpler than other bleeding risk assessing tools such as HAS-BLED and HEMORR2HAGES scores [31][32][33].…”

Section: Study Subjectsmentioning

confidence: 99%

Underutilization of warfarin for stroke prophylaxis in patients with atrial fibrillation or atrial flutter in Korea

Lee

Kim

2015

Journal of Cardiology

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Section: Study Subjectsmentioning

confidence: 99%

Underutilization of warfarin for stroke prophylaxis in patients with atrial fibrillation or atrial flutter in Korea

Lee

Kim

2015

Journal of Cardiology

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“…6,9 In the original HAS-BLED scheme for estimating bleeding risks in patients with AF treated with anticoagulation, a HAS-BLED score of 0-1 was considered low risk, a score of 2 was intermediate risk, and a score ≥3 was considered high risk for major bleeding. 10 For the purpose of this study, the score was stratified only for low/intermediate risk (HAS-BLED <3) vs high risk (HAS-BLED ≥3).…”

Section: Bleeding Risk Assessmentmentioning

confidence: 99%

Bleeding Risk Profile in Patients With Symptomatic Peripheral Artery Disease

et al. 2016

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PURPOSE To assess the bleeding risk profile using the HAS-BLED score in patients with symptomatic peripheral artery disease (PAD). METHODS A post hoc analysis was performed using data from a series of 115 consecutive patients (mean age 72.4±11.4 years; 68 men) with symptomatic PAD undergoing endovascular revascularization. The endpoint of the study was to assess bleeding risk using the 9-point HAS-BLED score, which was previously validated in cohorts of patients with and without atrial fibrillation. For the purpose of this study, the low (0-1), intermediate (2), and high-risk (3) scores were stratified as low/intermediate risk (HAS-BLED <3) vs high risk (HAS-BLED 3). RESULTS The mean HAS-BLED score was 2.76±1.16; 64 (56%) patients had a HAS-BLED score 3.0. Patients with PAD Rutherford category 5/6 ischemia had an even higher mean HAS-BLED score (3.20±1.12). Logistic regression analysis revealed aortoiliac or femoropopliteal segment involvement, chronic kidney disease, as well as Rutherford category 5/6, to be independent risk factors associated with a HAS-BLED score 3. CONCLUSION Patients with PAD, especially those presenting with Rutherford category 5/6 ischemic symptoms, have high HAS-BLED scores, suggesting increased risk for major bleeding. Prospective clinical validation of the HAS-BLED score in patients with PAD may help with the risk-benefit assessment when prescribing antithrombotic therapy.

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“…The risks of embolism and bleeding are respectively assessed using the: CHA 2 DS 2 Vasc score [2] and the HAS-BLED score [3] (Tables 1 and 2). …”

Section: New Oral Anticoagulantsmentioning

confidence: 99%

“…The therapeutic INR range in these diseases is between 2 and 3 because an INR of >3 increases the risk of bleeding, whereas an INR of <2 means the a suboptimal prevention of ischaemic stroke [1] ( Figure 1), and only a small percentage of patients fall into this category. Furthermore, the anticoagulant power of dicumarols is modified by food, drugs and malabsorbition syndromes.The risks of embolism and bleeding are respectively assessed using the: CHA 2 DS 2 Vasc score [2] and the HAS-BLED score [3] (Tables 1 and 2). …”

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confidence: 99%

Practical Guide to the New Oral Anticoagulants

S¹

2015

J Gen Pract

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New Oral AnticoagulantsOver the last few years, new oral anticoagulants (NOACs) have been developed and marketed for the treatment of non-Valvular Atrial Fibrillation (NVAF), Deep Venous Thrombosis (DVT) and, more recently, for pulmonary embolism (PE).The rationale underlying these new therapies is that they reduce the risks of embolic stroke and bleeding. Standard dicumarol therapy is characterised by a narrow therapeutic window that is reflected in the need for frequent monitoring of the international normalized ratio (INR). The therapeutic INR range in these diseases is between 2 and 3 because an INR of >3 increases the risk of bleeding, whereas an INR of <2 means the a suboptimal prevention of ischaemic stroke [1] ( Figure 1), and only a small percentage of patients fall into this category. Furthermore, the anticoagulant power of dicumarols is modified by food, drugs and malabsorbition syndromes.The risks of embolism and bleeding are respectively assessed using the: CHA 2 DS 2 Vasc score [2] and the HAS-BLED score [3] (Tables 1 and 2).Dabigatran, rivaroxaban and apixaban are three new drugs that have different mechanisms of action, daily doses, and metabolic and elimination profiles. y y Dabigatran (Pradaxa) is a direct thrombin inhibitor (it inhibits factor II) that has a half-life of about 12-14 hours and needs to be administered twice daily. It partially binds plasma proteins and can therefore be partially dialysed. Pradaxa is only eliminated renally: it is therefore contraindicated in patients whose creatinine clearance is <35 mL/min, and a reduced dose is mandatory when it is <50 mL/ min. y y Rivaroxaban (Xarelto) is a direct factor X inhibitor with a half-life of 5-13 hours, but completely binds plasma proteins. It is administered once daily with evening meal in NVAF patients, and twice daily in those with DVT or PE. It is eliminated by the kidney and liver, and can be used at a lower dose if creatinine clearance is <50 mL/min and >15 mL/min in NVAF patients; its use should be avoided in DVT/PE patients whose creatinine clearance is <30 ml/min. y y Apixaban (Eliquis) is a direct factor X inhibitor with a half-life of 9-14 hours, but completely binds plasma proteins. It is administered twice daily and eliminated by kidney and liver. It should not be used if creatinine clearance is <15 mL/min, and the dose should be reduced if it is <30 mL/min.The efficacy (primary endpoint: ischaemic or hemorrhagic stroke, systemic embolism) and safety (major bleeding) of these new drugs have been assessed in three clinical trials, [4-6] the results of which are summarised in Table 3. According to the ESC guidelines, [7] NOACs should be preferred to dicumarols in all patients with NVAF and a CHA2DS2Vasc score of >1 (Figure 2). ESC guideline indications1) Antithrombotc therapy (thromboembolism prophylaxis) is recommended for all male and female patients with atrial fibrillation (AF), except those at very low risk (age<65 years and AF alone) or with contraindications (class IA).2) The choice of antithrombotic therapy sh...

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Stroke and Bleeding Risk in Atrial Fibrillation: Navigating the Alphabet Soup of Risk‐Score Acronyms (CHADS₂, CHA₂DS₂‐VASc, R₂CHADS₂, HAS‐BLED, ATRIA, and More)

Cited by 51 publications

References 98 publications

Underutilization of warfarin for stroke prophylaxis in patients with atrial fibrillation or atrial flutter in Korea

Underutilization of warfarin for stroke prophylaxis in patients with atrial fibrillation or atrial flutter in Korea

Bleeding Risk Profile in Patients With Symptomatic Peripheral Artery Disease

Practical Guide to the New Oral Anticoagulants

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