CHA2DS2-VASc and HASBLED scores: Implications for thromboembolic prophylaxis in the elderly with atrial fibrillation - 07/05/13
Abstract |
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 CHA2DS2-VASc risk stratification. CHADS2 classified 32 (22.5%) patients at moderate risk, while CHA2DS2-VASc score classified all patients at high risk. Applying the HASBLED score, 57 (40.1%) had high haemorrhagic risk. Although by CHA2DS2-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 CHA2DS2-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.
Le texte complet de cet article est disponible en PDF.Keywords : Atrial fibrillation, Elderly, Thromboembolic prophylaxis, Risk stratification
Plan
Vol 4 - N° 2
P. 67-72 - avril 2013 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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