Atrial Fibrillation Paper

Atrial fibrillation (AF) is an important risk factor for ischemic stroke. AF increases the risk of stroke five fold and contributes to at least 15% of all strokes. Therefore, stroke prevention with the use of antithrombotic therapy is central to the overall management strategy of patients with AF. The first factor to consider is stroke risk assessment. The CHADS2 or CHA2DS2-VASc risk stratification method is used to direct the treatment of patients with AF by assessing a patient’s risk for stroke. CHADS2 assigns one point each for congestive heart failure, hypertension, age 75 or older, and diabetes, and two points for a previous stroke or transient ischemic attack (TIA). Compared to CHADS2 score, CHA2DS2-VASc score includes three additional factors: vascular disease (prior MI, PAD or aortic plaque), age 65-74 years, and female gender. Each additional factor counts as one point, while an age 75 or older was upgraded to two points. The CHA2DS2-VASc score includes categories of 0 (low risk), 1 (intermediate risk), and 2 or more (high risk). The 2014 AHA/ACC AF Guidelines recommend

The HAS-BLED score is recommended for bleeding risk assessment. HAS-BLED assigns one point for the presence of each of the following: hypertension (uncontrolled systolic blood pressure >160 mmHg), abnormal renal and/or liver function, previous stroke, bleeding history or predisposition, labile INR, elderly, and concomitant drugs and/or alcohol excess. The HAS-BLED scores range from 0-9, with scores of 3 or more indicating high bleeding risk. HAS-BLED allows providers to identify bleeding risk factors and correct modifiable risk factors in order to decrease the patient’s risk of bleeding. HAS-BLED bleeding risk assessment should not be used as a tool to exclude patients from getting anticoagulation therapy but rather identify patients in whom caution should be used with such