Skip to Main Content

++

Atrial fibrillation (AF) is associated with substantial risk of stroke and vascular embolism, affecting 2.2 million people in the United States, and 4.5 million people in the European Union.1 Thromboprophylaxis with oral anticoagulation (OAC) therapy has been the mainstay in reducing the risk of stroke and systemic embolism in patients with AF.2,3,4 Compared to OAC, anti-platelet therapy (i.e. aspirin, clopidogrel, etc.) is less effective in stroke prevention, and has similar rates of major bleeding, especially amongst elderly AF patients.3,5 Due to the steadily increasing number of AF patients that are being initiated on OAC, more attention has been given towards the estimation of both stroke and bleeding risk when determining an appropriate agent to use as prophylaxis.3 Traditionally, to determine whether a patient is a candidate for OAC, different stroke risk stratification schemes were used, with the most commonly used schematic and the one recommended by American College of Chest Physicians being the CHADS2 (or Congestive heart failure, Hypertension, Age ≥ 75 years old, Diabetes mellitus, and previous Stroke or transient ischemic attack [TIA]) scoring system.2,3,4 Stroke risk and bleeding risk are almost inseparable, and the CHADS2 scoring system does correlate closely with bleeding risk. As a result, many clinicians use CHADS2, and more recently have adopted CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥ 75 years old, Diabetes mellitus, and previous Stroke/TIA, Vascular disease, Age of 65 to 74 years old, female) as an assessment of bleeding risk in AF patients.3  

++

 

++

The HAS-BLED scoring system (also known as the Birmingham AF bleeding schema and stands for Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, and Drugs/alcohol concomitantly) is recommended in all major European and Canadian AF guidelines to estimate major bleeding risk in AF patients who are anticoagulated.2,3 HAS-BLED has been validated and shown to better predict the risk for serious bleeding in vitamin K antagonist (VKA, i.e., warfarin) and non-VKA anticoagulated clinical cohorts of AF, as well as in clinical practice.2,3

++

 

++

Roldan and colleagues conducted a retrospective cohort analysis to examine how effective the HAS-BLED scoring system was at predicting the rate of major bleeding in comparison to CHADS2 and CHA2DS2-VASc in AF patients on OAC. Subjects included in the analysis were those with permanent or paroxysmal AF receiving OAC therapy from the researcher’s outpatient anticoagulation clinic from 2007 and the first trimester of 2008.  Clinical parameters needed to calculate the HAS-BLED and CHA2DS2-VASc scores were available and were applied retrospectively. All patients were receiving the vitamin K antagonist, acenocoumarol, and consistently had INRs between 2-3 during the last 6 months. Subjects excluded from analysis were those with prosthetic heart valves, acute coronary syndrome, stroke (ischemic or embolic), valvular AF, or any hemodynamic instability, as well as anyone who had previous hospital ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.