Stroke and Bleeding Risk in Atrial Fibrillation

摘要: Non-valvular atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical setting. AF increases both risk and severity of strokes, associated with substantial morbidity mortality. Despite clear net benefit oral anticoagulants (OACs) patients at for stroke, major bleeding events, especially intracranial bleeds, may be devastating. In last decade, four new OACs have been approved stroke prevention are least as effective warfarin better profiles. These agents changed simplified our approach to because threshold initiation lowered. An important practice shift initial identification "low-risk" who do not need antithrombotic therapy, low-risk comprising CHA2DS2-VASc {Congestive heart failure, Hypertension, Age ≥75 years (double), Diabetes mellitus, previous Stroke/transient ischemic attack/thromboembolism Vascular disease, 65-74 years, female gender (score 0 males 1 female)}. Subsequent this step, consisting can offered one or more factors. Apart from risk, another consideration assessment, a focus on use validated HAS-BLED {Hypertension, Abnormal renal/liver function, Stroke, Bleeding history, Labile international normalized ratio (INR), Elderly (age >65 years), drugs alcohol concomitantly} score. A high score flag potentially bleeding, alert clinicians careful review follow up, consider correctable factors that include uncontrolled hypertension, labile INRs, concomitant aspirin use, excess.