Article

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: 14.43). 08/2012; 126(7):860-5. DOI: 10.1161/CIRCULATIONAHA.111.060061
Source: PubMed
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    • "Information on comorbidities was generated from ICD-9-CM codes in the clinical database with coding algorithms as described by Quan et al. [17]. The CHA 2 DS 2 -VASc score and Charlson comorbidity index were also calculated for each patient for risk stratification [18] [19] [20]. The initiation date and discontinuation date of AADs as well as information on other medications were ascertained via review of the institutional pharmacologic database and clinical notes and orders in the electronic medical record. "
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    ABSTRACT: Introduction Although there are many different antiarrhythmic drugs (AADs) approved for rhythm management of atrial fibrillation (AF), little comparative effectiveness data exist to guide drug selection. Methods We followed 5952 consecutive AF patients who were prescribed amiodarone (N = 2266), dronedarone (N = 488), dofetilide (N = 539), sotalol (N = 1718), or class 1C agents (N = 941) to the primary end point of AF recurrence. Results Median follow-up time was 18.2 months (range 0.1–101.6 months). Patients who were prescribed amiodarone had the highest, while patients on class 1C agents had the lowest baseline CHA2DS2-VASc score, Charlson comorbidity index, and burden of comorbid illnesses including coronary artery disease, congestive heart failure, diabetes mellitus, hyperlipidemia, chronic obstructive lung disease, chronic kidney disease, or cancer (p < 0.05 for all comparisons). After adjusting for baseline characteristics, using dronedarone as benchmark, amiodarone [hazard ratio (HR) 0.58, p < 0.001], class 1C agents (HR 0.70, p < 0.001), and sotalol (HR 0.79, p = 0.008), but not dofetilide (HR 0.87, p = 0.178) were associated with less AF recurrence. In addition, compared to dronedarone, amiodarone and class 1C agents were associated with lower rates of admissions for AF (HR 0.55, p < 0.001 for amiodarone; HR 0.71, p = 0.021 for class 1C agents) and all-cause mortality was lowest in patients treated with class 1C agents (HR 0.42, p = 0.018). The risk of stroke was similar among all groups. Conclusion Compared with dronedarone, amiodarone, class 1C agents, and sotalol are more effective for rhythm control, while dofetilide had similar efficacy. These findings have important implications for clinical practice.
    Full-text · Article · Jul 2015 · Journal of Cardiology
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    • "Information on comorbidities was generated from ICD-9-CM codes in the clinical database with coding algorithms as described by Quan et al. [17]. The CHA 2 DS 2 -VASc score and Charlson comorbidity index were also calculated for each patient for risk stratification [18] [19] [20]. The initiation date and discontinuation date of AADs as well as information on other medications were ascertained via review of the institutional pharmacologic database and clinical notes and orders in the electronic medical record. "

    Full-text · Article · May 2015 · Heart Rhythm
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    • "Other predictors of ICH may include the predictors of major bleeding (extra- and intracranial) that comprise the HAS-BLED score (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or pre-disposition, Labile INR, Elderly (>65), Drugs/alcohol concomitantly). A HAS-BLED score of >3 is considered ‘high risk’, although it should be noted that because this scoring system was developed for use in AF, its applicability to other patient groups is unclear (65,66). The risk of recurrent stroke and systemic embolism is likely to be greater in patients with AF and a high CHADS2 or CHA2DS2-VASc score, and transesophageal echocardiographic evidence of left ventricular dysfunction, left atrial enlargement, or left atrial thrombus (67,68). "
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    ABSTRACT: Each year, 1·0–2·0% of individuals with atrial fibrillation and 0·1–0·2% of those with venous thromboembolism who are receiving one of the novel oral anticoagulants (dabigatran, rivaroxaban, or apixaban) can be expected to experience an acute ischemic stroke. Additionally, 0·2–0·5% of individuals with atrial fibrillation who are receiving one of the novel oral anticoagulants can be expected to experience an intracranial hemorrhage. This opinion piece addresses the current literature and offers practical approaches to the management of patients receiving novel oral anticoagulants who present with an ischemic or hemorrhagic stroke. Specifically, we discuss the role of thrombolysis in anticoagulated patients with acute ischemic stroke and factors to consider concerning restarting anticoagulation after acute ischemic and hemorrhagic stroke.
    Full-text · Article · Jun 2014 · International Journal of Stroke
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