The HAS-BLED Score Has Better Prediction Accuracy for Major Bleeding Than CHADS2 or CHA2DS2-VASc Scores in Anticoagulated Patients With Atrial Fibrillation

Roldán, Vanessa; Marı́n, Francisco; Manzano‐Fernández, Sergio; Gallego, Pilar; Vı́lchez, Juan Antonio; Valdés, Mariano; Vicente, Vicente; Lip, Gregory Y.H.

doi:10.1016/j.jacc.2013.08.1623

Cited by 176 publications

(117 citation statements)

References 31 publications

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“…The observed low risk of ICH among warfarin users in patients with a low CHA 2 DS 2 -VASc score in the present study is consistent with a previous report. 34 The results of our NCB analyses also favored the use of warfarin compared with nontreatment (or aspirin), irrespective of different weighted models, whereas antiplatelet therapy had a negative NCB compared with nontreatment. Based on the results of NCB analyses, the number needed to treat with warfarin use ranged from 152 to 159 compared with nontreatment and ranged from 77 to 101 compared with antiplatelet drugs in different weight models.…”

Section: Discussionmentioning

confidence: 65%

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Chao

Lip

Liu

et al. 2016

Stroke

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A trial fibrillation (AF) confers a 5-fold increased risk of stroke compared with patients without AF. 1 The risk of AF-associated stroke is not homogeneous and depends on patients' age and comorbidities, which have resulted in the development of clinical scores to aid stroke risk stratification and guide the use of oral anticoagulation (OAC) for stroke prevention. Currently, the CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female) score is recommended by guidelines for stroke risk stratification in AF 2,3 and has been shown to be better than the older CHADS 2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score for stroke risk stratification among Asian AF patients. 4 Because age is an important driver of ischemic stroke for AF patients, 5 the CHA 2 DS 2 -VASc scheme assigns 1 point forBackground and Purpose-The age threshold for an increased stroke risk for patients with atrial fibrillation may be different for Asians and non-Asians. We hypothesized that a modified CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65-74 years, female) scheme, mCHA 2 DS 2 -VASc, which assigned one point for patients aged 50 to 74 years, may perform better than CHA 2 DS 2 -VASc score for stroke risk stratification in Asians. Methods-This study used the Taiwan National Health Insurance Research Database, which included 224 866 newly diagnosed atrial fibrillation patients. The predictive accuracies of ischemic stroke of CHA 2 DS 2 -VASc and mCHA 2 DS 2 -VASc scores were compared among 124 271 patients without antithrombotic therapies. From the whole cohort, 15 948 patients had a CHA 2 DS 2 -VASc score 0 (males) or 1 (females), and 8654 patients had an mCHA 2 DS 2 -VASc score 1 (males) or 2 (females). The latter were categorized into 3 groups, that is, no treatment, antiplatelet therapy, and warfarin, and the risks of ischemic stroke and intracranial hemorrhage (ICH) were compared. Results-During a follow-up of 538 653 person-years, 21 008 patients experienced ischemic stroke. The mCHA 2 DS 2 -VASc performed better than CHA 2 DS 2 -VASc score in predicting ischemic stroke assessed by C indexes and net reclassification index. For 8654 patients having an mCHA 2 DS 2 -VASc score of 1 (males) or 2 (females) because of the resetting of the age threshold, use of warfarin was associated with a 30% lower risk of ischemic stroke and a similar risk of ICH compared with nontreatment. Net clinical benefit analyses also favored the use of warfarin in different weighted models. patients aged between 65 and 74 years and 2 points for those aged ≥75 years. 6 However, the age threshold for an increased risk of ischemic stroke for Asians may be lower than that of Caucasians. Conclusions-In7 For Asian AF patients with a CHA 2 DS 2 -VASc score of 0 (males)...

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Section: Discussionmentioning

confidence: 65%

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Chao

Lip

Liu

et al. 2016

Stroke

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“…At discharge, older age was also found to be related to a lower prescription probability (Table 4). Cirrhosis and stroke, other variables taken into consideration when evaluating bleeding risk in the HAS-BLED score [31], were also associated with lower prescription rates; however, these associations were not statistically significant.…”

Section: Oral Anticoagulant Therapymentioning

confidence: 86%

Brain and kidney, victims of atrial microembolism in elderly hospitalized patients? Data from the REPOSI study

Corrao

Argano

Nobili

et al. 2015

European Journal of Internal Medicine

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“…65 yaş öncesi sadece kadın cinsiyetten 1 puan alan hastalar dahil olmak üzere ASA veya OAK önerilmemektedir. Aynı kılavuzda kanama riskide HASBLED skoruyla belirlenmiştir [36,37] Atriyal fibrilasyonda tedavi seçeneği günü-müzde altta yatan sebebe göre değişmektedir. Valvüler AF'de warfarin sodyum elimizdeki tek seçe-nek olarak görülmekle beraber non-valvuler AF'de yeni oral antikoagülan ilaçlar umut vaat etmektedir.…”

Section: Antikoagülan Kullanımı Ve Süresiunclassified

Current approaches in atrial fibrillation treatment

Sarı¹

2014

Dicle Med J

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Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. Its incidence increases with age. AF is classified into subtypes according to the duration and/or able to provide sinus rhytym. İnitially, patients should be evaluated for rhythm or rate control for appropriate treatment. Second stage of strategy aimed to investigate the feasibility of anticoagulation therapy. Recently, due to the progress made in treatment with rhythm control and anticoagulation therapy, either American or European guidelines have been renovated. These developments have taken place in the newly published guide. In this article, the current change in the management of AF is discussed. Key words: atrial fibrillation, rhythm, anticoagulation ÖZETAtriyal fibrilasyon (AF) klinik pratikte en sık görülen disritmi olup insidansı yaşla birlikte artış göstermektedir. Sinüs ritminini sağlayabilmeye ve oluşum süresine göre AF sınıflandırılmaktadır. Tedavi, ilk olarak hastaların ritm kontrolü veya hız kontrolü açısından uygunluğunun değerlendirilmesiyle başlar. Strateji belirlendikten sonra ikinci aşamada antikoagülan tedavinin gerekliliği araştırılır. Son zamanlarda hem ritm kontrolü hem de antikoagülan tedavide kaydedilen gelişmeler gerek Amerikan gerekse Avrupa kılavuzlarının birbiri ardına yenilenmesini gerekli kılmıştır. Bu gelişmeler yeni yayınlanan kılavuzlarda yerini almış olup bu yazıda atriyal fibrilasyon tedavisinde yaşanan bu güncel değişimler ele alınmıştır. Anahtar kelimeler: Atriyal fibrilasyon, ritim, antikoagülas-yon GİRİŞAtriyal fibrilasyon (AF) en sık görülen kardiyak ritm bozukluğu olup sıklığı yaşla birlikte artmaktadır. Gelişmiş ülkelerde prevelansı %1,5-2 olup ül-kemizde yapılan TEKHARF çalışmasındaki verilere göre pervelansı %1,25'tir [1,2]. Otonomik fokus teorisi ve multiple reentran dalga hipotezi olmak üzere iki farklı oluşum mekanizması öne sürülmüş-tür. Multiple reentran dalga hipotezinde jeneralize olarak tüm atrial dokuda iletim bozukluğu olduğu kabul edilir. Otonomik fokus teorisi ilk olarak Haissequerre ve ark. tarafından öne sürülmüş olup pulmoner ven ağızları ablasyonu ile atriyal fibrilasyonun sinus ritmine çevrildiğinin gösterilmesiyle popülerlik kazanmıştır [3].Atriyal fibrilasyon, sinus ritmine döndürüle-bilmesi ve oluşum süresine bağlı olarak sınıflandı-rılmaktadır. Genellikle ilk 48 saatte spontan olarak sinüs ritmine dönen ve 7 gün veya daha az süren formu paroksismal AF; 7 gün üzerinde süren ve kardiyoversiyonla sinüs ritmine dönebilen formuna persistan AF, 1 yılın üzerinde kardiyoversiyonla sinüs ritmine dönme ihtimali olan formuna uzun süreli persistan AF, sinus ritmine dönme ihtimalini olmayan formuna permenant (kalıcı) AF denir [4]. Avrupa kılavuzundan uyarlanan algoritma Şekil 1'de görülmektedir. Başka bir sınıflandırma ise; kalp kapak patolojilerine bağlı oluşan valvular AF (protez kalp kapağı, romatizmal mitral kapak hastalığı, tamir edilmiş mitral kapak) ve herhangi bir

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The HAS-BLED Score Has Better Prediction Accuracy for Major Bleeding Than CHADS2 or CHA2DS2-VASc Scores in Anticoagulated Patients With Atrial Fibrillation

Cited by 176 publications

References 31 publications

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Brain and kidney, victims of atrial microembolism in elderly hospitalized patients? Data from the REPOSI study

Current approaches in atrial fibrillation treatment

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The HAS-BLED Score Has Better Prediction Accuracy for Major Bleeding Than CHADS2 or CHA2DS2-VASc Scores in Anticoagulated Patients With Atrial Fibrillation

Cited by 176 publications

References 31 publications

Validation of a Modified CHA 2 DS 2 -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Validation of a Modified CHA 2 DS 2 -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Brain and kidney, victims of atrial microembolism in elderly hospitalized patients? Data from the REPOSI study

Current approaches in atrial fibrillation treatment

Contact Info

Product

Resources

About

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation

Validation of a Modified CHA ₂ DS ₂ -VASc Score for Stroke Risk Stratification in Asian Patients With Atrial Fibrillation