Atrial Fibrillation: Stroke and bleeding Risk Assessment
Keywords:
Atrial fibrillation, Stroke, Bleeding, Risk assessmentAbstract
Atrial fibrillation increases with increased elderly population and it increases the risk of thromboembolism that may lead to stroke. Both CHADS2 and CHA2DS2 VAS scores are widely used to assess the stroke risk according to current international guidelines. The accuracy of both scores in predicting stroke risk is only modest. Some important clinical risk factors are missing of those scores such as chronic kidney disease, Body Mass Index BMI, echocardiographic abnormalities and other biomarkers. Assessment of bleeding risk using HEMORR2HAGES, HAS-BLED, and ATRIA scores are discussed in detail.
References
Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, et al. “ACC/ AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society”. Circulation 114(2006): 257-354.
Lip GY, Lim HS. “Atrial fibrillation and stroke prevention”. Lancet Neurol 6(2007): 981-93.
Wolf PA, Abbott RD, WB. Kannel. “Atrial fibrillation as an independent risk factor for stroke: the Framingham Study”. Stroke 22(1991): 983-988.
Wang G, Tong X and George MG. “Atrial Fibrillation Associated Costs for Stroke Hospitalizations of Medicare Beneficiaries in the Stroke Belt of the United States”. J Atr Fibrillation 5(2013):7-11.
Patel M.R, Mahaffey KW, Garg J, Pan G, Singer DE, et al. “ Rivaroxaban versus warfarin in nonvalvular atrial fibrillation”. N Engl J Med 365(2011): 883-891.
Camm AJ, Lip GYH, Caterina RD, Savelieva I, Atar D, et al. “2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation”. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 33(2012):2719-2747.
Friberg L, Bergfeldt L. “Atrial fibrillation prevalence revisited”. J Intern Med 2013 274:461-468.
Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, et al. “ Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study”. JAMA 285(2001):2370-2375.
Sussman M, Menzin J, Lin I, Kwong WJ, Munsell M, et al. “Impact of atrial fibrillation on stroke-related healthcare costs”. J Am Heart Assoc 2(2013):000479.
Soliman EZ, Safford MM, Muntner P, Khodneva Y,et al. “Atrial Fibrillation and the Risk of Myocardial Infarction”. JAMA Intern Med 174(2014): 107-114.
Savelieva I, Camm AJ. “ Clinical relevance of silent atrial fibrillation: prevalence, prognosis, quality of life, and management”. J Interv Card Electrophysiol 4(2000):369-382.
Lin HJ. “Newly diagnosed atrial fibrillation and acute stroke. The Framingham Study”. Stroke 26(1995):1527-1530.
Page RL, Wilkinson WE, Clair WK, McCarthy EA, Pritchett EL. “Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia”. Circulation, 89(1994): 224-227.
Binici Z, Intzilakis T, Nielsen OW, Kober L, Sajadieh A, et al. “Excessive supraventricular ectopic activity and increased risk of atrial fibrillation and stroke”. Circulation 121(2010):1904-1911.
Healey JS, Connolly SJ, Gold MR, Israel CW, Gelder ICV, et al. “Subclinical atrial fibrillation and the risk of stroke”. N Engl J Med 366(2012):120-129.
Flaker GC, Belew K, Beckman K, Vidaillet H, Kron J, et al. “ Asymptomatic atrial fibrillation: demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study”. Am Heart J 149(2005):657- 663.
Hohnloser SH, Pajitnev D, Pogue J, Healey JS, Pfeffer MA, et al. “Incidence of stroke in paroxysmal versus sustained atrial fibrillation in patients taking oral anticoagulation or combined antiplatelet therapy: an ACTIVE W Substudy”. J Am Coll Cardiol 50(2007): 2156-2161.
Capucci A, Santini M, Padeletti L, Gulizia M, Botto GL, et al. “ Monitored atrial fibrillation duration predicts arterial embolic events in patients suffering from bradycardia and atrial fibrillation implanted with antitachycardia pacemakers”. J Am Coll Cardiol 46(2005):1913-1920.
Glotzer TV, Daoud EG,Wyse G, Singer DE, Ezekowitz MD, et al. “The relationship between daily atrial tachyarrhythmia burden from implantable device diagnostics and stroke risk: the TRENDS study”. Circ Arrhythm Electrophysiol 2(2009): 474-480.
Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, et al. “ Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation”. JAMA 285(2001): 2864-2870.
Welles CC, Whooley MA, Na B, Ganz P, Schiller NB,et al. “ The CHADS2 score predicts ischemic stroke in the absence of atrial fibrillation among subjects with coronary heart disease: data from the Heart and Soul Study”. Am Heart J 162(2011):555-561.
Benjamin EJ, Levy D, Vaziri S M, D’Agostino R B,Belanger A J, et al. “Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study”. JAMA 271(1994): 840-844.
Kerr CR, Humphries K. “ Gender-related differences in atrial fibrillation”. J Am Coll Cardiol 46(2005):1307-1308.
Karthikeyan G, Eikelboom JW. “ The CHADS2 score for stroke risk stratification in atrial fibrillation--friend or foe? ”.Thromb Haemost 104(2010):45-48.
Nieuwlaat R, Capucci A, Lip GYH, Olsson SB, Prins MH, et al. “Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation”. Eur Heart J 27 (2006):3018-3026.
Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM, et al. “Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factorbased approach: the euro heart survey on atrial fibrillation”. Chest 137(2010): 263-272.
“Independent predictors of stroke in patients with atrial fibrillation: a systematic review”. Neurology 69(2007): 546-554.
Banerjee A, Taillandier S, Olesen JS, Lane DA, Lallemand B, et al. “Ejection fraction and outcomes in patients with atrial fibrillation and heart failure: the Loire Valley Atrial Fibrillation Project”. Eur J Heart Fail 14(2012):295-301.
“Echocardiographic predictors of stroke in patients with atrial fibrillation: a prospective study of 1066 patients from 3 clinical trials”. Arch Intern Med 158(1998):1316-1320.
Shelton RJ, Clark AL, Kaye GC, Cleland JGF. “The atrial fibrillation paradox of heart failure”. Congest Heart Fail 16(2010): 3-9.
MD E. “Echocardiographic predictors of stroke in patients with atrial fibrillation: a prospective study of 1066 patients from 3 clinical trials”. Arch Intern Med 158(1998):1316-1320.
Aronow WS, Ahn C, Kronzon I, Gutstein H. “Risk factors for new thromboembolic stroke in patients > or = 62 years of age with chronic atrial fibrillation”. Am J Cardiol 82(1998):119-121.
Friberg L, Rosenqvist M,Lip GY. “Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study”. Eur Heart J 33(2012):1500-1510.
Van Staa TP, Setakis E, Di Tanna G L,Lane D A, Lip G Y H. “A comparison of risk stratification schemes for stroke in 79,884 atrial fibrillation patients in general practice”. J Thromb Haemost 9(2011):39-48.
Olesen JB, Lip GYH, Hansen ML, Hansen PR, Tolstrup JS,et al. “Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: nationwide cohort study”. BMJ 342(2011):124.
Olesen JB, Fauchier L, Lane DA, Taillandier S, Lip GYH,et al. “Risk factors for stroke and thromboembolism in relation to age among patients with atrial fibrillation: the Loire Valley Atrial Fibrillation Project”. Chest 141(2012):147-153.
Evans W, Swann P. “Lone auricular fibrillation”. Br Heart J 16(1954):189-194.
Frost L. Lone atrial fibrillation: good, bad, or ugly? ”. Circulation 115(2007):3040-3041.
Friberg L, Benson L, Rosenqvist M, Lip GYH. “Assessment of female sex as a risk factor in atrial fibrillation in Sweden: nationwide retrospective cohort study”. BMJ 344(2012):3522. DOI: 10.47755/2766-9556.100110
Hart RG, Pearce LA,Aguilar MI. “ Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation”. Ann Intern Med 146(2007):857-867.
Nieuwlaat R, Olsson SB, Lip GYH, Camm AH, Breithardt G,et al. “Guideline-adherent antithrombotic treatment is associated with improved outcomes compared with undertreatment in high-risk patients with atrial fibrillation. The Euro Heart Survey on Atrial Fibrillation”. Am Heart J 153(2007):1006-10012.
Mant J, Hobbs FDR, Fletcher K, Roalfe A, Fitzmaurice D,et al. “ Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial”. Lancet 370(2007): 493-503.
Hughes M, Lip GY. “Risk factors for anticoagulation-related bleeding complications in patients with atrial fibrillation: a systematic review”. QJM 100(2007): 599-607.
Palareti G, Cosmi B. “Bleeding with anticoagulation therapy - who is at risk, and how best to identify such patients”. Thromb Haemost 102(2009):268-278.
Gage BF,Yan Y, Milligan PE, Waterman AD, Culverhouse R, et al. “Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF) ”. Am Heart J 151(2006): 713-719.
Fang MC, Go AS,Chang Y, Borowsky LH, Pomernacki NK, et al. “A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study”. J Am Coll Cardiol 58(2011):395-401.
Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJGM, et al. “A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey”. Chest 138(2010):1093-1100.
Lip GY, Frison L, Halperin JL, Lane DA. “Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score”. J Am Coll Cardiol 57(2011):173-180.
Olesen JB, Lip GYH, Hansen P R, Lindhardsen J,Ahlehoff O, et al. “Bleeding risk in ‘real world’ patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort”. J Thromb Haemost 9(2011):1460-1467.
Apostolakis S, Lane DA, Guo Y, Buller H, Lip GYH. “Performance of the HEMORR(2)HAGES, ATRIA, and HAS-BLED bleeding risk-prediction scores in patients with atrial fibrillation undergoing anticoagulation: the AMADEUS (evaluating the use of SR34006 compared to warfarin or acenocoumarol in patients with atrial fibrillation) study”. J Am Coll Cardiol 60 (2012):861-867.
Roldan V,Martin F, Fernandez H, Manzano-Fernandez S, Gallego P, et al. “ Predictive value of the HAS-BLED and ATRIA bleeding scores for the risk of serious bleeding in a “real-world” population with atrial fibrillation receiving anticoagulant therapy”. Chest 143(2013):179-184.
