Decisions about anticoagulation means balancing the benefit of stroke reduction against the risk of haemorrhage using scoring systems.
Before starting anticoagulation, clinicians should use a stratification scheme for stroke and haemorrhage to help balance the risks and benefits.6 The ESC/EHRA guidelines recommend the CHA2DS2-VASc (Table 6 and Figure 18) score to predict stroke risk in AF patients.
Table 6. CHA2DS2-VASc scoring system for assessing stroke risk.6
In addition, clinicians should use a bleeding risk stratification scheme, such as HAS-BLED (Table 7 and Figure 18) to assess haemorrhage risk and identify risk factors (Table 8) for major bleeding in people taking anticoagulants. Biomarkers, such as high-sensitivity troponin and natriuretic peptide, can help further assess the risk of stroke and bleeding risk in AF.5
Table 7. HAS-BLED scoring system for assessing haemorrhage risk.5
Table 8. Risk factors for haemorrhage in patients taking anticoagulants.5,38
The next section features an introduction to anticoagulation therapy