Table 2.
Preoperative Scoring Systems for Relative Risk of Thromboembolic and Hemorrhagic Complications in Patients on Preoperative Anticoagulants (Sources31-35).
| Scale | CHADS2 | CHADS2 VASc | HAS-BLED | HEMORR2HAGES | ATRIA–Stroke | ATRIA–Bleed | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Used for | Stroke risk | Stroke risk | Major bleeding when on anticoagulation | Major bleeding in elderly patients with Afib | Stroke risk | Bleeding risk in patient on warfarin | ||||||
| Score | Element | Patients | Element | Patients | Element | Patients | Element | Patients | Element | Patients | Element | Patients |
| CHF | 1 | CHF | 1 | HTN | 1 | Liver/kidney disease | 1 | Prior CVA/TIA | Anemia | 3 | ||
| HTN | 1 | HTN | 1 | ESRD | 1 | EtOH abuse | 1 | Age | ESRD | 3 | ||
| Age ≥75 y | 1 | Age ≥75 y | 2 | Liver disease | 1 | Hx cancer | 1 | Female sex | 1 | Age ≥75 y | 2 | |
| DM | 1 | DM | 1 | Prior CVA/TIA | 1 | Age >75 y | 1 | DM | 1 | Prior major bleed | 1 | |
| Prior CVA/TIA | 2 | Prior CVA/TIA | 2 | Prior major bleed | 1 | ↓ Platelet count or function | 1 | CHF | 1 | HTN | 1 | |
| PVD/MI | 1 | Labile INR | 1 | Prior major bleed | 2 | HTN | 1 | |||||
| Age 65-74 y | 1 | Age >65 y | 1 | HTN | 1 | Proteinuria | 1 | |||||
| Female sex | 1 | On antiplatelets or anticoagulants | 1 | Anemia | 1 | ESRD | 1 | |||||
| >8 drinks/wk | 1 | CYP 2C9 mutation | 1 | |||||||||
| ↑ Fall risk | 1 | |||||||||||
| Prior CVA/TIA | 1 | |||||||||||
| Interpretation | Score | Riska | Score | Risk | Score | Riskb | Score | Riskc | Score | Riskd | Score | Scoree |
| 0 | 0.6% | 0 | 0.2% | 0 | 1.13 | 0 | 1.9 | 0 | 0.08 | 0 | 0.40 | |
| 1 | 3.0% | 1 | 0.6% | 1 | 1.02 | 1 | 2.5 | 1 | 0.43 | 1 | 0.55 | |
| 2 | 4.2% | 2 | 2.2% | 2 | 1.88 | 2 | 5.3 | 2 | 0.99 | 2 | 0.97 | |
| 3 | 7.1% | 3 | 3.2% | 3 | 3.74 | 3 | 8.4 | 3 | 073 | 3 | 1.01 | |
| 4 | 11.1% | 4 | 4.8% | 4 | 8.70 | 4 | 10.4 | 4 | 0.64 | 4 | 2.62 | |
| 5 | 12.5% | 5 | 7.2% | 5-9 | — | ≥ 5 | 12.3 | 5 | 0.99 | 5 | 5.65 | |
| 6 | 13.0% | 6 | 9.7% | 6 | 1.91 | 6 | 4.95 | |||||
| 7 | 11.2% | 7 | 2.50 | 7 | 5.17 | |||||||
| 8 | 10.8% | 8 | 3.86 | 8 | 9.61 | |||||||
| 9 | 12.2% | ≥9 | 4.3-16.4 | 9-10 | 12.4-17.3 | |||||||
Abbreviations: Afib, atrial fibrillation; CHF, congestive heart failure; CVA, cerebral vascular accident; DM, diabetes mellitus; ESRD, end-stage renal disease; HTN, hypertension; Hx, history of; MI, myocardial infarction; PVD, peripheral vascular disease; TIA, transient ischemic attack.
a Risk is annual stroke rate.
b Bleeds per 100 patient-year.
c Bleeds per 100 patient-year.
d Thromboembolic events per 100 patient-year.
e Bleeds per 100 patient-year.