Stroke Prevention, Evaluation of Bleeding Risk, and Anticoagulant Treatment Management in Atrial Fibrillation Contemporary International Guidelines

Accuracy of HAS‐BLED and other bleeding risk assessment tools in predicting major bleeding events in atrial fibrillation: A network meta‐analysis

“…Moreover, although HAS‐BLED has modest value for predicting bleeding, it could be used for general AF patients. Therefore, the bleeding risk assessment at baseline should be conducted to stratify the risk of AF patients and controlling potential risk factors to improve the overall bleeding risk . Finally, the simple and practical use of bleeding risk assessment tools should be considered in clinical practices in busy settings.…”

Tailored oral anticoagulant prescription in patients with atrial fibrillation: Use and misuse of clinical risk prediction scores

“…1 Nowadays, all the current international guidelines recommend unanimously that AF patients need to be treated with oral anticoagulant (OAC) drugs, with the only exception of patients at low thromboembolic risk. 2 Among the available OAC drugs, again the guidelines uniformly indicate the non-vitamin K antagonist OACs (NOACs) as the preferred treatment compared with vitamin K antagonists (VKAs), on the basis of evidence indicating a similar (even superior) effectiveness and a safer clinical profile. 2 Recent epidemiological evidence confirmed that on these premises the overall rate of OAC prescription has significantly increased in the recent years.…”

“…2 Among the available OAC drugs, again the guidelines uniformly indicate the non-vitamin K antagonist OACs (NOACs) as the preferred treatment compared with vitamin K antagonists (VKAs), on the basis of evidence indicating a similar (even superior) effectiveness and a safer clinical profile. 2 Recent epidemiological evidence confirmed that on these premises the overall rate of OAC prescription has significantly increased in the recent years. 3 Notwithstanding the clear indications coming from the guidelines, a high baseline bleeding risk is commonly considered as a major contraindication to withhold OAC prescription.…”

“…4 This practice may occur despite the fact that all the guidelines agree that a high bleeding risk at baseline evaluation is not a sufficient reason for avoiding prescription of OAC. 2 Rather than doing this, a high bleeding risk should be a reason to flag patients that should receive specific interventions in order to control and modulate all the modifiable and potentially modifiable bleeding risk factors. 2 In the study presented by Gamble et al, published in the European Journal of Preventive Cardiology, which focused on a cohort of AF patients experiencing a stroke event, the majority of patients (64%) reported both a high thromboembolic risk (based on CHA 2 DS 2 -VASc score) and a high bleeding risk (based on a modified version of the HEMORR 2 HAGES score).…”

“…2 Rather than doing this, a high bleeding risk should be a reason to flag patients that should receive specific interventions in order to control and modulate all the modifiable and potentially modifiable bleeding risk factors. 2 In the study presented by Gamble et al, published in the European Journal of Preventive Cardiology, which focused on a cohort of AF patients experiencing a stroke event, the majority of patients (64%) reported both a high thromboembolic risk (based on CHA 2 DS 2 -VASc score) and a high bleeding risk (based on a modified version of the HEMORR 2 HAGES score). 5 The authors analyzed the prescription of OAC prior to stroke occurrence and found that only two thirds of patients with high thromboembolic and bleeding risks were treated with OAC before the occurrence of event.…”