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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

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