1. Stroke Risk: Assess the patient’s risk of stroke to determine if the patient is a candidate for anticoagulation. Risk of stroke can be determined by using the CHA2DS2 VASc calculator . A link is provided on the tool bar to the right. The scoring system assigns a point value to different medical conditions for each patient. Once the points are assigned, the total point value is calculated which correlated to a specific percentage for annual stroke risk. The scoring system and corresponding stroke risk can be found below.
CHA2DS2 VASc scoring system
CHA2DS2 VASc annual stroke risk
2. Bleeding risk: bleeding risk can be calculated using the HAS-BLED score, ATRIA bleeding score and CHADS2 or CHA2DS2-VASc scores.
When considering bleeding risk, it is also important to consider the following to minimize risk of bleeding:
- Look for potential drug-drug interactions on the patients medication list
- Use proton pump inhibitors
- Avoid non-steroidal anti-inflammatory medications
- Avoid aspirin use when possible
3. Consideration of anticoagulation: The 2014 ACC/AHA/HRS guidelines recommend using the risk of stroke together with shared decision making with the patient taking into account patient values and preferences.
The following is a sample treatment algorithm by the European Society of Cardiology in 2012: