Stroke and Bleeding Risk Assessment in Atrial Fibrillation: Where Are We Now?
Ling KuoYi-Hsin ChanJo-Nan LiaoShih-Ann ChenTze Fan ChaoPublished in: Korean circulation journal (2021)
Most important international guidelines recommend the use of CHA₂DS₂-VASc and HAS-BLED scores for stroke and bleeding risk assessments in atrial fibrillation (AF) patients, respectively. The 2020 AF guidelines of European Society of Cardiology have revised the definition of "C: congestive heart failure (HF)" component, and now patients with either HF with reduced ejection fraction or preserved ejection fraction should be assigned 1 point. Hypertrophic cardiomyopathy was also included. Besides, the revised "V: vascular diseases" component included both prior myocardial infarction and "angiographically significant coronary artery disease". It is important to understand that the stroke and bleeding risks of AF patients were not static and should be re-assessed regularly. A high HAS-BLED score itself should not be the only reason to withhold or discontinue oral anticoagulants, but remind physicians for the corrections of modifiable bleeding risk factors and more regular follow up. In the future, the AF duration and left atrial function may play an important role for personalized evaluation of individual stroke risk while more studies are necessary.
Keyphrases
- atrial fibrillation
- left atrial
- oral anticoagulants
- ejection fraction
- heart failure
- catheter ablation
- left atrial appendage
- direct oral anticoagulants
- end stage renal disease
- percutaneous coronary intervention
- hypertrophic cardiomyopathy
- aortic stenosis
- risk assessment
- coronary artery disease
- risk factors
- chronic kidney disease
- left ventricular
- newly diagnosed
- primary care
- clinical practice
- acute heart failure
- mitral valve
- patient reported outcomes
- coronary artery bypass grafting
- acute kidney injury
- brain injury
- cardiac surgery
- cardiac resynchronization therapy
- subarachnoid hemorrhage