Table 5.
Recommended risk assessment tools for stroke risk, bleeding risk and successful vitamin K antagonist-based anticoagulation in patients with atrial fibrillation.
| Risk of stroke |
Risk of bleeding |
Likelihood TTR ≥ 70% (choosing between VKA or NOAC) |
|||
|---|---|---|---|---|---|
| CHA2DS2VASc score (Lip, 2010) |
HAS-BLED score (Pisters et al., 2010) |
SAMe-TT2 R2 score (Apostolakis et al., 2013d) |
|||
| Condition or characteristic | Points | Condition or characteristic | Points | Definition | Points |
| Congestive heart failure | 1 | Hypertension | 1 | Sex (female) | 1 |
| Hypertension | 1 | Abnormal renal and liver function (1 point each) | 1 or 2 | Age (< 60 y) | 1 |
| Age ≥ 75 y | 2 | Stroke | 1 | Medical historya | 1 |
| Diabetes mellitus | 1 | Bleeding tendency/predisposition (anaemia) | 1 | Treatment (interacting drugs, eg, amiodarone for rhythm control) | 1 |
| Stroke/TIA/SE | 2 | Labile INRs (eg, TTR < 60%) | 1 | Tobacco use (within 2 y) | 2 |
| Vascular disease (prior ACS, PAD, or aortic plaque) | 1 | Elderly (eg, age > 65 y, frail condition) | 1 | Race (not white) | 2 |
| Age 65–74 y | 1 | Drugsbc or alcohol excess (1 point each) | 1 or 2 | 8 | |
| Sex category (ie, female sex)a | 1 | 9 | |||
| Maximum score | 9 | ||||
Abbreviations: VKA—vitamin K antagonist, NOAC—non-vitamin K oral antagonist, TTR—time in therapeutic range, TIA—transient ischaemic attack, SE—systemic embolism, ACS—acute coronary syndrome, PAD—peripheral arterial disease, INR—international normalised ratio.
Two of the following: hypertension, diabetes mellitus, coronary artery disease or myocardial infarctions, peripheral artery disease, congestive heart failure, previous stroke, pulmonary disease, or hepatic or renal disease.
Concomitant antiplatelet drugs, Steroids, non-steroidal anti-inflammatory drugs.
Counts only in the presence of another risk factor.