Risk stratification for thrombosis risk and anticoagulation

By rray, 25 January, 2024
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<sup>1</sup> Hindricks G, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. <i>Eur Heart J.</i> 2021 Feb 1;42(5):373-498. <a href=https://academic.oup.com/eurheartj/advance-article-pdf/doi/10.1093/eurheartj/ehaa612/33799442/ehaa612.pdf><u>Free, full-text PDF</u></a>
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Use validated score e g CHA2DS2 VASc If male pt w CHA2DS2 VASc score of 1 or female pt w CHA2DS2 VASc score of 2 remains uncertain about the benefit of anticoagulation consider other factors that might modify their stroke risk to help inform the decision
Stroke risk is based on score and risk factors not AF pattern
If congenital heart dz or HCM anticoagulate regardless of stroke risk score
Re evaluate annually
Evaluate for bleeding risks prior bleeding anemia meds Bleeding risk scores perform poorly Do not use in isolation ESC recommends HAS BLED score 1
Contraindications to long term anticoagulation nbsp nbsp Severe bleeding due to a nonreversible cause involving the GI pulmonary or GU systems nbsp nbsp Spontaneous intracranial intraspinal bleeding due to a nonreversible cause nbsp nbsp Serious bleeding
Long term anticoagulation reasonable if nbsp nbsp Treatable GI pulmonary or GU system nbsp nbsp Bleeding related to isolated trauma nbsp nbsp Bleeding related to procedural complications
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Risk stratification for thrombosis risk and anticoagulation: