SPAF

Question 1

What are the components in the CHA2DS2VASc score?

Answer 1

Congestive Heart Failure
Hypertension
Diabetes Mellitus
Prior stroke or transient ischaemic attack
Vascular disease (prior MI, peripheral artery disease or aortic plaque)
Age 65-74
Age ≥75 (2 points)

Question 2

How should CHA2DS2VASc score be interpreted?

Answer 2

0 = No anticoagulants
Reassess stroke risk at least annually, and when clinical circumstances change

1 = Consider anticoagulation
Not all risk factors amount to same risk
(higher risk: 65-74yo, HF pt ≥35yo, HTN pt ≥50yo, DM pt ≥50yo, Vascular disease pt ≥55yo)

2 = Start anticoagulation (DOAC > Warfarin)
(Bleeding risk should be mitigated, but should not deter anticoagulation Tx)

Question 3

What are the components in the HAS-BLED score?

Answer 3

Uncontrolled hypertension (systolic >160 mmHg)
Abnormal renal function: Dialysis, renal transplant, SCr > 200μmol
Abnormal liver function: cirrhosis or bilirubin x2 ULN, or AST/ALT/ALP > 3x ULN
Stroke Hx
Bleeding Hx or predisposition
Labile INRs (unstable or high INRs, or <6 out of 10 INR readings were within INR range)
Elderly (>65yo) or extremely frail
Drugs (eg antiplatelet medications or NSAIDs)
Alcohol (>14 units for men, >7 women per week)

Question 4

How is the HAS-BLED score interpreted?

Answer 4

≥3 indicates high bleeding risk
- Monitor more frequently
- Take steps to reduce bleeding risk
- Educate patient and caregivers on recognising signs and symptoms of bleeding

**HASBLED is meant to identify risk factors behind high bleeding risk, should not stop you from giving anticoagulation to those who need it (esp if high CHA2DS2VASc)