atrial fibrillation and stroke prevention - Continuing Medical ...
atrial fibrillation and stroke prevention - Continuing Medical ... atrial fibrillation and stroke prevention - Continuing Medical ...
Essentials in Primary Care Conference Wednesday, July 31, 2013 Bleeding Risk Scores Widely Used in Atrial Fibrillation • HEMORR 2 HAGES-2006 1 • HAS-BLED-2010 2 • ATRIA Score-2011 3 1.Gage BF, et al. Am Heart J. 2006 Mar;151(3):713-9. PMID: 16504638. 2.Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. Chest. 2010 Nov;138(5):1093-100. 3.Fang MC, et al. J Am Coll Cardiol. 2011 Jul 19;58(4):395-401. Bleeding Risk Scores in AF ATRIA HAS-BLED HEMORR 2 HAGES Anemia 1 3 Hypertension 4 1 Severe renal disease 2 3 Abnormal Renal 5 or 1 Liver function 6 1 Hepatic 10 or 1 Renal disease 2 1 Ethanol abuse 1 Age 75 yrs 2 Stroke 1 Malignancy 1 Any prior hemorrhage 1 Bleeding 1 Older Age (>75 yrs) 1 Hypertension 3 1 Labile INR 8 1 Reduced platelet number or function 11 1 Elderly (>75 yrs) 1 Rebleeding 12 2 Drugs 9 or Alcohol abuse 1. Hemoglobin
Essentials in Primary Care Conference Wednesday, July 31, 2013 HASBLED Risk #points Major Bleeding High Risk (>4%/yr) Moderate Risk (2-4%/yr) Low Risk ( 4 pts 6-16%/yr 2-3 pts 2- 4%/yr 0-1 pts 0-1%/yr Pisters R, et al. Chest 2010: 138: 1093 Lip GY, et al J Am Coll Cardiol. 2011;57(2):173-180. Roldan V et al. Chest 2013 Jan; 143: 179. Bleeding Risk Prediction Generally Poor: The HAS-BLED Score Best Improves The Reclassification of One’s Bleeding Risk • Investigators compared the HAS-BLED, ATRIA, and older HEMORRHAGES score in A Fib cohort • Independent predictors of bleeding were age > 75, and age > 65, alcohol excess, anemia, and heart failure • Bleeding Risk Estimations by Clinicians is Poor and Anticoagulant Prescribing Does Not Reflect Bleeding Risk • HAS-BLED score performed well and helped reclassify bleeding risk over other bleeding risk scores tested. Lip GY et al. Circ Arrhythm Electrophysiol. 2012; 5:941-948. Roldan V et al. Chest 2013 Jan; 143: 179. Jan Basile, MD Atrial Fibrillation & Stroke Prevention
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Essentials in Primary Care Conference<br />
Wednesday, July 31, 2013<br />
Bleeding Risk Scores Widely<br />
Used in Atrial Fibrillation<br />
• HEMORR 2 HAGES-2006 1<br />
• HAS-BLED-2010 2<br />
• ATRIA Score-2011 3<br />
1.Gage BF, et al. Am Heart J. 2006 Mar;151(3):713-9. PMID: 16504638.<br />
2.Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. Chest. 2010 Nov;138(5):1093-100.<br />
3.Fang MC, et al. J Am Coll Cardiol. 2011 Jul 19;58(4):395-401.<br />
Bleeding Risk Scores in AF<br />
ATRIA HAS-BLED HEMORR 2<br />
HAGES<br />
Anemia 1 3 Hypertension 4 1<br />
Severe renal disease 2 3<br />
Abnormal Renal 5 or 1<br />
Liver function 6 1<br />
Hepatic 10 or<br />
1<br />
Renal disease 2 1<br />
Ethanol abuse 1<br />
Age 75 yrs 2 Stroke 1 Malignancy 1<br />
Any prior hemorrhage 1 Bleeding 1 Older Age (>75 yrs) 1<br />
Hypertension 3 1 Labile INR 8 1<br />
Reduced platelet number<br />
or function 11 1<br />
Elderly (>75 yrs) 1 Rebleeding 12 2<br />
Drugs 9 or<br />
Alcohol abuse<br />
1. Hemoglobin
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