Practical-Manual-Scores-Algorithms-Haemostasis-Thrombosis

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Atrial FibrillationBleeding risk in anticoagulated patientswith atrial fibrillationIndicationMajor complication in anticoagulated patients is bleeding, intracranialhaemorrhage being the most severe manifestation (0.8-1%/patients/year).In the ESC guidelines, bleeding risk assessment is also recommended usingthe HAS-BLED score. The HAS-BLED score is validated for VKA and non-VKAanticoagulants, and is the only bleeding risk score predictive for intracranialhaemorrhage. Other studies have validated HAS-BLED in atrial fibrillation (AF)and non-AF patients, those undergoing bridging therapy, and in bleeding relatedto PCI/stenting.HAS-BLED scoreHAS-BLEDScoreHypertension i.e. uncontrolled Blood Pressure 1Abnormal renal/liver function 1 or 2Stroke 1Bleeding tendency or predisposition 1Labile INR 1Elderly (e.g., > 65, frail condition) 1Drugs (e.g. concomitant aspirin or NSAIDs) or alcohol excess or abuse 19InterpretationA high HAS-BLED score (≥ 3) should not be used as a reason for withholdingOAC but is indicative of the need for regular review and follow-up. A highHAS-BLED score also makes us consider the potentially reversible riskfactors for bleeding, for example, the H in HAS-BLED stands for uncontrolledblood pressure (so to reduce risk, BP should be controlled), the L stands forlabile INRs, and D for concomitant use of aspirin/NSAIDs in anticoagulatedpatients, etc. Those patients with a high HAS-BLED score derive a higher netclinical benefit when balancing ischaemic stroke and intracranial bleeding.28
References• Friberg L, Rosenqvist M, Lip G. Net clinical benefit of warfarin in patients withatrial fibrillation: A report from the Swedish atrial fibrillation cohort study.Circulation. 2012;125:2298-307.• Lip GY, Andreotti F, Fauchier L, et al.; European Heart Rhythm Association.Bleeding risk assessment and management in atrial fibrillation patients. ExecutiveSummary of a Position Document from the European Heart Rhythm Association[EHRA], endorsed by the European Society of Cardiology [ESC] Working Group on<strong>Thrombosis</strong>. Thromb Haemost. 2011;106:997-1011.• Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (has-bled) toassess 1-year risk of major bleeding in patients with atrial fibrillation: The EuroHeart Survey. Chest. 2010;138:1093-100.Atrial Fibrillation29
Page 1 and 2: Practical manualScores and Algorith
Page 3: Scientific boardHenri BounameauxDiv
Page 6 and 7: SummaryBleedingISTH bleeding assess
Page 9 and 10: Clinical probability model for deep
Page 11 and 12: FeatureGeneva scoresPoints(revised
Page 13 and 14: InterpretationClinical decision rul
Page 15 and 16: 6 features with a similar validity.
Page 17 and 18: Prediction of recurrent deep vein T
Page 19 and 20: Outpatient versus inpatient care in
Page 21 and 22: Assessment of post-thrombotic syndr
Page 23 and 24: Diagnostic algorithm in suspected p
Page 25 and 26: Prediction of stroke risk in patien
Page 27: References• Camm AJ, Lip GY, De C
Page 31 and 32: InterpretationThis score identifies
Page 33 and 34: Vienna score (Ay Model): DVT or PE
Page 35 and 36: Risk assessment modelsin hospitaliz
Page 37 and 38: References• Chopard P, Spirk D, B
Page 39 and 40: Recommendations for the determinati
Page 41 and 42: Template for scoring system for non
Page 43 and 44: Diagnosis of Thrombotic Thrombocyto
Page 45 and 46: Management of patientswith occlusio
Page 47 and 48: Symptoms(up to the time of diagnosi
Page 49 and 50: InterpretationA bleeding score > 3
Page 51 and 52: Pediatric Bleeding scoreSymptoms Sc
Page 53 and 54: Bleeding assessment tool for the ev
Page 55 and 56: The SMOG system (cont.)Type of blee
Page 57 and 58: The SMOG system (cont.)Type of blee
Page 59 and 60: Diagnostic and therapeutic algorith
Page 61 and 62: Bridging strategies in patients on
Page 64: Practical manualof scores and algor

Practical-Manual-Scores-Algorithms-Haemostasis-Thrombosis

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