Scores predicting bleeding risk in AF
Scores predicting bleeding risk in AF
Anticoagulation is vital for reducing the risk of stroke in atrial fibrillation (AF). There are several scores predicting bleeding risk in AF. These can be used to weigh between the need for anticoagulation and the risk of bleeding with it while taking an individualised decision.
HAS-BLED: Hypertension, Abnormal liver or renal function, Stroke, Bleeding, Labile INRs, Elderly (>65 years), Drugs or Ethanol Abuse
HEMORR2HAGES: (Hepatic or Renal Disease, Ethanol Abuse, Malignancy History, Older than age 75, Reduced platelet count or function, Rebleeding risk, Hypertension, Anemia, Genetic factors (CYP2C9 single nucleotide polymorphisms), Excessive fall risk, Stroke history
ATRIA: Anemia, severe renal disease, Age 75 or older, Any prior hemorrhage diagnosis, Hypertension history
ORBIT: Outcomes Registry for Better Informed Treatment
In a post hoc analysis of clinically relevant and major bleeding in the around 2300 patients on warfarin in the AMADEUS trial, HAS-BLED score was shown to be better performing than ATRIA and ORBIT scores [1]. They could improve the predictive value of ATRIA and ORBIT by adding the time in therapeutic range (TTR) of warfarin to the scores.
References
Senoo K, Proietti M, Lane DA, Lip GY. Evaluation of the HAS-BLED, ATRIA, and ORBIT Bleeding Risk Scores in Patients with Atrial Fibrillation Taking Warfarin. Am J Med. 2016 Jun;129(6):600-7
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Source: Cardiophile MD - Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
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