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Scores Predicting Bleeding Risk in AF

Description: https://johnsonfrancis.org/profession... Discussion on scores predicting bleeding risk in AF with anticoagulation. Anticoagulation is vital for reducing the risk of stroke in atrial fibrillation. There are several scores predicting bleeding risk in AF. These can be used to weigh between the need for anticoagulation and the risk of bleeding with it while taking an individualized decision. HAS-BLED: Hypertension, Abnormal liver or renal function, Stroke, Bleeding, Labile INRs, Elderly (more than 65 years), Drugs or Ethanol Abuse. Drugs are antiplatelet agents or non-steroidal anti-inflammatory drugs used concomitantly. Maximum number of points possible on the HAS BLED score is 9. HAS BLED scoring is based on the EuroHeart Survey involving about four thousand subjects with atrial fibrillation. In this study, number of bleeds per 100 patient years ranged from 1.13 to 12.5 when scores increased from 0 to 5. There were only two patients with a score of 6 and no patient had scores above 6. While deciding on long term oral anticoagulation the risk of bleeding should be less than the risk due to stroke for a beneficial effect of anticoagulation to be obtained. HEMORR2HAGES: (Hepatic or Renal Disease, Ethanol Abuse, Malignancy History, Older than age 75, Reduced platelet count or function, Rebleeding risk, Hypertension, Anemia, Genetic factors (CYP2C9 single nucleotide polymorphisms), Excessive fall risk, Stroke history. ATRIA: Anemia, severe renal disease, Age 75 or older, Any prior hemorrhage diagnosis, Hypertension history. ORBIT: Outcomes Registry for Better Informed Treatment. It may be noted that most scores have the same variables which increased risk of stroke in the scores for recommending anticoagulation in AF. In a post hoc analysis of clinically relevant and major bleeding in the around 2300 patients on warfarin in the AMADEUS trial, HAS-BLED score was shown to be better performing than ATRIA and ORBIT scores.