We are full of ‘scoring systems’ and ways of calculating risk. Here are two important ones. If you have a smart-phone, there
will be some type of calculator on there for you to use. The important thing is to know that they exist.
The CHADS2 score is a means of assessing who needs anticoagulation, in our AF patients. It analyses the risk of stroke.
CHADS2 Arch Int Med 2003
C – congestive cardiac failure 1 point
H – hypertension 1 point
A – age > 75 1 point
D – Diabetes 1 point
S – stroke/TIA 2 points
The stroke rate for 0 points is < 1.9%
In cases of 0-1 point consider Aspirin.
The threshold point is 1 point.
At > 1 point give warfarin unless the contraindications are significant.
There is a risk of bleeding in patients on anticoagulation.
The HAS BLED score is a validated score (J Am Coll Cardiol; 2011:57:181-183)
A score of greater than 2 has an increased one year risk of bleeding.
Here is the score.
H – hypertension 1 point
A – abnormal liver/renal function 2 points
S – stroke 1 point
B – bleeding history 1 point
L – labile INR 1 point
E – elderly >65 years old 1 point
D – drus/alcohol increasing bleeding risk 2 points
Peter Kas
