This review provides an overview of stroke and bleeding risk assessment in atrial fibrillation, focusing on the appropriate use of the CHADS2, CHA2DS2-VASc, and HAS-BLED risk stratification schemes.
How should stroke and bleeding risk be assessed in patients with atrial fibrillation to guide thromboprophylaxis?
This review highlights the importance of using structured risk scores like CHA2DS2-VASc and HAS-BLED to balance stroke and bleeding risks when deciding on thromboprophylaxis in atrial fibrillation.
Decision making with regard to thromboprophylaxis should be based upon the absolute risks of stroke/thromboembolism and bleeding and the net clinical benefit for a given patient. As a consequence, a crucial part of atrial fibrillation (AF) management requires the appropriate use of thromboprophylaxis, and the assessment of stroke as well as bleeding risk can help inform management decisions by clinicians. The objective of this review article is to provide an overview of stroke and bleeding risk assessment in AF. There would be particular emphasis on when, how, and why to use these risk stratification schemes, with a specific focus on the CHADS2 congestive heart failure, hypertension, age, diabetes, stroke (doubled), CHA2DS2-VASc congestive heart failure or left ventricular dysfunction, hypertension, age ≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female), and HAS-BLED hypertension (i.e. uncontrolled blood pressure), abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR (if on warfarin), elderly (e.g. age >65, frail condition), drugs (e.g. aspirin, NSAIDs)/alcohol concomitantly risk scores.
Gregory Y.H. Lip (Thu,) conducted a review in Atrial fibrillation. Stroke and bleeding risk assessment (CHADS2, CHA2DS2-VASc, HAS-BLED) was evaluated. This review provides an overview of stroke and bleeding risk assessment in atrial fibrillation, focusing on the appropriate use of the CHADS2, CHA2DS2-VASc, and HAS-BLED risk stratification schemes.