CHA₂DS₂-VASc + HAS-BLED

Stroke and bleeding risk assessment in atrial fibrillation

CHA₂DS₂-VASc

Stroke risk

Age
Sex
CHF history
Hypertension
Stroke / TIA / thromboembolism
Vascular disease
Diabetes

HAS-BLED

Major bleeding risk

Hypertension
Uncontrolled systolic BP >160 mmHg
Abnormal renal / liver function
Renal or hepatic dysfunction
Stroke history
Bleeding history / predisposition
Labile INR
Age ≥65 years
Drugs / alcohol
Concomitant drugs or alcohol use

References

  1. Lip, G. Y. H., Nieuwlaat, R., Pisters, R., Lane, D. A., & Crijns, H. J. G. M. (2010). Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The Euro Heart Survey on atrial fibrillation. Chest, 137(2), 263–272. https://doi.org/10.1378/chest.09-1584
  2. Pisters, R., Lane, D. A., Nieuwlaat, R., de Vos, C. B., Crijns, H. J. G. M., & Lip, G. Y. H. (2010). A novel user-friendly score, HAS-BLED, to assess 1-year risk of major bleeding in patients with atrial fibrillation: The Euro Heart Survey. Chest, 138(5), 1093–1100. https://doi.org/10.1378/chest.10-0134
  3. Gage, B. F., Waterman, A. D., Shannon, W., Boechler, M., Rich, M. W., & Radford, M. J. (2001). Validation of clinical classification schemes for predicting stroke: Results from the National Registry of Atrial Fibrillation. JAMA, 285(22), 2864–2870. https://doi.org/10.1001/jama.285.22.2864
  4. January, C. T., Wann, L. S., Calkins, H., Chen, L. Y., Cigarroa, J. E., Cleveland, J. C., Jr., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., Furie, K. L., Heidenreich, P. A., Murray, K. T., Shea, J. B., Tracy, C. M., & Yancy, C. W. (2019). 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Circulation, 140(2), e125–e151. https://doi.org/10.1161/CIR.0000000000000665
  5. Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., Gorenek, B., Hess, P. L., Hlatky, M., Hogan, G., Ibeh, C., Indik, J. H., Kido, K., Kusumoto, F., Link, M. S., ... Wyse, D. G. (2024). 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation. Circulation, 149(1), e1–e156. https://doi.org/10.1161/CIR.0000000000001193