Blood thinners – risk of stroke vs risk of bleeding in Atrial Fibrillation

Whether to start or not blood thinners in Atrial Fibrillation depends on a strict mathematic formula, which depicts your risk of stroke versus your risk of bleeding

The decision to start blood thinners is based on your risk factors for stroke calculated against your risk of bleeding .

The risk of stroke is based on CHADSVASc score points and the risk of bleeding is based on your HASBLED points .

CHADSVASc Score and Stroke Risk

A score of > 1 was shown to predict a significant ischemic stroke rate , warranting anticoagulation .

C Congestive heart failure 1

H Hypertension Resting BP > 140/90 mmHg or current antihypertensive pharmacologic treatment. 1

A Age 75 years or older. 2

A Age 65 to 74 years. 1

D Diabetes mellitus. 1

S Stroke, TIA, 2

V Vascular disease. 1

A Arterial disease , Prior MI, peripheral arterial disease, or aortic plaque. 1

S Sex category (female) Female gender confers higher risk. 1

HASBLED score and bleeding risk

HASBLED is a scoring system developed to assess the risk of major bleeding in patients taking anticoagulants with atrial fibrillation

H Hypertension: (uncontrolled, >160 mmHg systolic). 1

A Abnormal renal function: Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L 1

A Abnormal liver function: Cirrhosis or Bilirubin >2x Normal or AST/ALT/AP >3x Normal. 1

S Stroke: Prior history of stroke. 1

B Bleeding: Prior Major Bleeding or Predisposition to Bleeding. 1

L Labile INR: (Unstable/high INR), 1

E Elderly: Age > 65 years. 1

D Prior Alcohol or Drug Usage History (≥ 8 drinks/week). 1