Table 1.
Risk scales for predicting stroke and risk of bleeding
| Stroke risk
|
Bleeding risk
|
|||
|---|---|---|---|---|
| CHADS210 | CHA2 DS2-VASc9 | HEMORR2 HAGES59 | HAS-BLED11 | ATRIA60 |
| Age ≥75 years (1 point) | Age ≥75 years (2 points), age 65–74 years (1 point) | Age >75 years (1 point) | Age >65 years (1 point) | Age ≥75 years (2 points) |
| History of stroke or TIA (2 points) | Previous stroke/TIA/thromboembolism (2 points) | Stroke (1 point) | Stroke (previous history, particularly lacunar) (1 point) | |
| Hypertension (1 point) | Hypertension (1 point) | Hypertension (1 point) | Hypertension (1 point) | Hypertension (1 point) |
| CHF (1 point) | CHF/left ventricular dysfunction (1 point) | Hepatic/renal disease (1 point) | Abnormal renal/liver function (1 point each) | Severe renal disease (eGFR <30 mL/min or dialysis-dependent) (3 points) |
| Diabetes mellitus (1 point) | Diabetes mellitus (1 point) | Prior bleed (2 points) | Bleeding history or predisposition (anemia) (1 point) | Any prior hemorrhage diagnosis (1 point) |
| Vascular disease (prior myocardial infarction, peripheral artery disease, or aortic plaque) (1 point) | Anemia (1 point) | Anemia (3 points) | ||
| Female sex (1 point) | Reduced platelet count or function (1 point) | Labile INR (therapeutic time in range <60%) (1 point) | ||
| Ethanol abuse (1 point) | Drugs (antiplatelet agents, nonsteroidal anti-inflammatory drugs) or alcohol excess (≥8 units/week) (1 point each) | |||
| Malignancy (1 point) Genetic factors (CYP2C9 single-nucleotide polymorphisms) (1 point) Excessive fall risk (1 point) |
||||
Notes: Reprinted from Chest, 137(2), Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation. 263–272. Copyright 2010 with permission from Elsevier.9 Reprinted from Chest, 138(5), Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. 1093–1100. Copyright 2010, with permission from Elsevier.11
Abbreviations: ATRIA, Anticoagulation and Risk Factors in Atrial Fibrillation; CHA2DS2-VASc, Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, Stroke, transient ischemic attack, Vascular disease, Age 65–74 years, Sex category; CHADS2, Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke, TIA, or non-central nervous system thromboembolism doubled; CHF, congestive heart failure; eGFR, estimated glomerular filtration rate; HAS-BLED, Hypertension, Abnormal renal/liver function, Stroke, Bleeding history, Labile international normalized ratio, Elderly, Drugs/alcohol; HEMORR2HAGES, Hepatic or renal disease, Ethanol abuse, Malignancy, Older age, Reduced platelet count or function, Re-bleeding, Hypertension, Anemia, Genetic factors, Excessive fall risk, and Stroke; INR, international normalized ratio; TIA, transient ischemic attack.