Stroke and bleeding risk stratification in atrial fibrillation: a critical appraisal

Lane, Deirdre A ORCID: 0000-0002-5604-9378 and Lip, Gregory YH (2020) Stroke and bleeding risk stratification in atrial fibrillation: a critical appraisal. EUROPEAN HEART JOURNAL SUPPLEMENTS, 22 (O). pp. 14-27.

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Official URL: http://dx.doi.org/10.1093/eurheartj/suaa178

Abstract

Atrial fibrillation (AF) significantly increases the risk of stroke and, therefore, stroke prevention is an essential component of the management for patients with AF. This requires formal assessment of the individual risk of stroke to determine if the patient is eligible for oral anticoagulation (OAC), and if so, their risk of bleeding on OAC, before a treatment decision regarding stroke prevention is made. Risk of stroke is not homogenous; it depends on the presence or absence of risk factors. A plethora of stroke and bleeding risk factors has been identified, including common and less-well established clinical risk factors, plus imaging, urine, and blood biomarkers. Consequently, there are several stroke and bleeding risk stratification scores available and this article provides an overview of them, the risk factors included and how they are scored, and provides a critical appraisal of them. The review also discusses the debate regarding whether female sex is a risk factor or a risk modifier, and highlights the dynamic nature of both stroke and bleeding risk and the need to re-assess these risks periodically to ensure treatment is optimal to reduce the risk of adverse outcomes. This review also summarizes the recommended stroke and bleeding risk stratification scores from all current major international guidelines.

Item Type:	Article
Uncontrolled Keywords:	Stroke, Bleeding, Risk stratification, Atrial fibrillation, Risk scores, CHA(2)DS(2)-VASc, HAS-BLED
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	19 Apr 2021 09:27
Last Modified:	18 Jan 2023 22:53
DOI:	10.1093/eurheartj/suaa178
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3119456