Table 3.
Framework for application of prognostic risk scores for variable treatment benefit, variable treatment harm to particularise a treatment recommendation
| Risk for stroke (CHADS2) |
|||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Score | 0 | 1 | 2 | 3 | 4 | 5 | 6 | ||||
| Predicted BLRstroke (%/year) | 1.9 | 2.8 | 4.0 | 5.9 | 8.5 | 12.5 | 18.2 | ||||
| Risk for bleed (HEMORR2HAGES) |
Predicted ARRstroke (95% CI) %/year* | 1.22 (0.93 to 1.41) | 1.79 (1.37 to 2.07) | 2.56 (1.96 to 2.96) | 3.78 (2.89 to 4.37) | 5.44 (4.17 to 6.29) | 8.00 (6.13 to 9.25) | 11.65 (8.92 to 13.5) | |||
| Score | Predicted BLRbleed, %/year warfarin |
Predicted ARIbleed (95% CI) %/year† |
Required ARRstroke (95% CI) @ RVbleed/stroke 0.6 %/year |
Tentative treatment recommendation‡ | |||||||
| Yes | No | ||||||||||
| 0 | 1.9 | 0.83 | 1.07 (0.07 to 3.23) | 0.64 (0.04 to 1.94) | T | T | T | T | T | T | T |
| 1 | 2.5 | 1.09 | 1.41 (0.09 to 4.24) | 0.85 (0.05 to 2.54) | T | T | T | T | T | T | T |
| 2 | 5.3 | 2.30 | 3.00 (0.18 to 8.95) | 1.80 (0.11 to 5.37) | DT | CC | T | T | T | T | T |
| 3 | 8.4 | 3.65 | 4.75 (0.29 to 14.2) | 2.85 (0.17 to 8.52) | DT | DT | DT | T | T | T | T |
| 4 | 10.4 | 4.52 | 5.88 (0.36 to 17.6) | 3.53 (0.22 to 10.6) | DT | DT | DT | T | T | T | T |
| ≥ 5 | 12.3 | 5.35 | 6.95 (0.43 to 20.8) | 4.17 (0.26 to 12.5) | DT | DT | DT | DT | T | T | T |
Example: Warfarin versus placebo for stroke reduction in patients with atrial fibrillation.
*Predicted ARRstroke and 95% CI if RRRstroke is 0.64 (0.49 to 0.74) using warfarin.11
†Predicted ARIbleed and 95% CI if RRIbleed is 1.30 (0.08 to 3.89) using warfarin.11
‡Tentative treatment recommendations are based on predicted point estimates for ARRstroke and ARIbleed. Uncertainties in these estimates, indicated by 95% CIs above, must also be considered before actual treatment recommendations can be derived.
ARI, absolute risk increase; ARR, absolute risk reduction; BLR, baseline risk; CC, close all; DT, do not treat; RV, relative value; T, treat.