Use of the CHA(2)DS(2)-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation.
University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Rd, Birmingham, B18 7QH, UK.Circulation (Impact Factor: 15.2). 08/2012; 126(7):860-5. DOI:10.1161/CIRCULATIONAHA.111.060061
- Europace 08/2012; 14(10):1385-413. · 2.77 Impact Factor
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ABSTRACT: PURPOSE OF REVIEW: Although the overall complication rate in cardiac surgery has been decreased, perioperative bleeding increasing morbidity and mortality is still frequent. Furthermore, the widespread use of new antithrombotic and antiplatelet agents presents an additional challenge in daily practice. Therefore, identifying patients with increased bleeding risk would be advantageous to optimize perioperative management. RECENT FINDINGS: Bleeding classifications are frequently discussed, but are of little relevance for the perioperative setting. In the nonsurgical setting the most relevant risk factors in bleeding prediction are age, renal disease, sex, pre-existing anemia, and the administration of antithrombotic/antiplatelet drugs. In cardiac surgery, the Papworth Bleeding Risk Stratification Score identifies mainly procedure-linked risk factors and might be one of the most suitable scores to be used. Routine laboratory screening appears to have limited utility. SUMMARY: Apart from precise bleeding history only insufficient data exist in cardiac surgery to exactly predict bleeding complications. Therefore, there is urgent need for further studies to improve perioperative bleeding management.Current opinion in anaesthesiology 12/2012;
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