The European Heart Journal has featured a study evaluating the risk of stroke and bleeding in atrial fibrillation, and the application of the CHA2DS2-VASc and HAS-BLED schemes for stroke and bleeding risk assessments, respectively.

Data from the Swedish Atrial Fibrillation cohort study, a nationwide cohort study of 182,678 subjects with a diagnosis of AF at any Swedish hospital between 1 July 2005 and 31 December 2008, and who were prospectively followed for 1.5 years were reviewed. All patients who used an oral anticoagulant anytime during follow-up were identified, and most of the analyses were made on a subset of 90,490 patients who never used anticoagulants. Risk factors for stroke, the composite thromboembolism endpoint (stroke, TIA, or systemic embolism), and bleeding, and the performance of published stroke and bleeding risk stratification schemes were investigated. The researchers reported that associations were found between the following ‘new’ risk factors and thromboembolic events: peripheral artery disease [hazard ratio (HR) 1.22 (95% CI 1.12–1.32)], ‘vascular disease’ [HR 1.14 (1.06–1.23)], prior myocardial infarction [HR 1.09 (1.03–1.15)], and female gender [HR 1.17 (1.11–1.22)]. Composite thromboembolic endpoint with the CHADS2 and CHA2DS2-VASc schemes were similar, at 0.66 (0.65–0.66) and 0.67 (0.67–0.68), respectively. Additionally, the ability for predicting intracranial haemorrhage (ICH) and major bleeding with both bleeding risk schemes (HEMORR2HAGES, HAS-BLED) were similar.

The researchers conclude that the CHA2DS2- VASc score was good at identifying ‘truly low risk’ subjects, and the HAS-BLED score can be correlated to ICH risk, with a similar predictive ability to older bleeding risk stratification schemes, although the HAS-BLED score has the advantage of simplicity.