TY - JOUR
T1 - CHA2DS2-VASc and HASBLED scores
T2 - Implications for thromboembolic prophylaxis in the elderly with atrial fibrillation
AU - Araújo, I.
AU - Fonseca, C.
AU - Cardiga, R.
AU - Dores, H.
AU - Ferreira, R.
AU - Gândara, F.
AU - Proença, M.
AU - Marques, F.
AU - Leitão, A.
AU - Ceia, F.
PY - 2013/4/1
Y1 - 2013/4/1
N2 - Background: The prevalence of atrial fibrillation increases substantially with age. As atrial fibrillation carries a higher risk of thromboembolic events, several scores have been developed to estimate thromboembolic and bleeding risk in order to help with the prophylactic decision. Objective: To determine thromboembolic and bleeding risk of elderly with atrial fibrillation according to CHADS2, CHA2DS2-VASc and HASBLED and its repercussions on thromboembolic prophylaxis. Methods: Retrospective, observational study including 142 consecutively hospitalized patients over 65 years old, with non-valvular atrial fibrillation/flutter. CHADS2 and CHA2DS2-VASc were applied and compared and HASBLED score was used to estimate haemorrhagic risk. The adequacy of prescribed antithrombotic therapy was evaluated. Long-term follow-up of thromboembolic and haemorrhagic events was carried out. Results: None of the elderly patients were allocated to the low-risk category according to CHADS2 and CHA 2DS2-VASc risk stratification. CHADS2 classified 32 (22.5%) patients at moderate risk, while CHA2DS 2-VASc score classified all patients at high risk. Applying the HASBLED score, 57 (40.1%) had high haemorrhagic risk. Although by CHA 2DS2-VASc all patients had a formal indication for anticoagulation, only 77 (54.2%) were anticoagulated. Age was found to be a common criteria for withholding oral anticoagulation. The thromboembolic event rate was 2.6% for anticoagulated patients and 11.5% for not anticoagulated ones, while major haemorrhages occurred in 6.5% anticoagulated and 1.5% not anticoagulated patients. Conclusions: All elderly with atrial fibrillation had high thromboembolic risk, better predicted by CHA2DS 2-VASc. Anticoagulation, the only factor that can alter prognosis, was underused despite the evidence of the scores. Paradoxically, age alone was frequently considered a contra-indication for anticoagulation.
AB - Background: The prevalence of atrial fibrillation increases substantially with age. As atrial fibrillation carries a higher risk of thromboembolic events, several scores have been developed to estimate thromboembolic and bleeding risk in order to help with the prophylactic decision. Objective: To determine thromboembolic and bleeding risk of elderly with atrial fibrillation according to CHADS2, CHA2DS2-VASc and HASBLED and its repercussions on thromboembolic prophylaxis. Methods: Retrospective, observational study including 142 consecutively hospitalized patients over 65 years old, with non-valvular atrial fibrillation/flutter. CHADS2 and CHA2DS2-VASc were applied and compared and HASBLED score was used to estimate haemorrhagic risk. The adequacy of prescribed antithrombotic therapy was evaluated. Long-term follow-up of thromboembolic and haemorrhagic events was carried out. Results: None of the elderly patients were allocated to the low-risk category according to CHADS2 and CHA 2DS2-VASc risk stratification. CHADS2 classified 32 (22.5%) patients at moderate risk, while CHA2DS 2-VASc score classified all patients at high risk. Applying the HASBLED score, 57 (40.1%) had high haemorrhagic risk. Although by CHA 2DS2-VASc all patients had a formal indication for anticoagulation, only 77 (54.2%) were anticoagulated. Age was found to be a common criteria for withholding oral anticoagulation. The thromboembolic event rate was 2.6% for anticoagulated patients and 11.5% for not anticoagulated ones, while major haemorrhages occurred in 6.5% anticoagulated and 1.5% not anticoagulated patients. Conclusions: All elderly with atrial fibrillation had high thromboembolic risk, better predicted by CHA2DS 2-VASc. Anticoagulation, the only factor that can alter prognosis, was underused despite the evidence of the scores. Paradoxically, age alone was frequently considered a contra-indication for anticoagulation.
KW - Atrial fibrillation
KW - Elderly
KW - Risk stratification
KW - Thromboembolic prophylaxis
UR - http://www.scopus.com/inward/record.url?scp=84877585426&partnerID=8YFLogxK
U2 - 10.1016/j.eurger.2012.10.004
DO - 10.1016/j.eurger.2012.10.004
M3 - Article
AN - SCOPUS:84877585426
SN - 1878-7649
VL - 4
SP - 67
EP - 72
JO - European Geriatric Medicine
JF - European Geriatric Medicine
IS - 2
ER -