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Critical Care and Anaesthesia
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rajkumar Rajendram, Alex Joseph, John Davidson, Avinash Gobindram, Prit Anand Singh, Animesh JK Patel
How is the long-term risk of bleeding with anticoagulation assessed?The HAS-BLED score can be used. This includes hypertension, age over 65, abnormal liver or kidney function, previous bleeding or predisposition, labile INR, stroke, drug or alcohol use.These risk scores have not been validated in surgical populations but can provide a useful estimate of risk. The decision on whether or not to initiate anticoagulation is complex; patients and their relatives should be involved.
Supraventricular rhythms
Published in Andrew R Houghton, Making Sense of the ECG, 2019
A HAS-BLED score ≥3 indicates a ‘high risk’ for bleeding, but this does not necessarily preclude the use of anticoagulant therapy Rather, the principal use of the HAS-BLED score should be to help identify modifiable risk factors for bleeding, which might then be managed to reduce the risk.
Patient risk assessment: Use of risk calculators
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
The HAS-BLED score is a commonly used estimate of major bleeding risk in 1-year in patients with atrial fibrillation, which aids in the risk-benefit assessment of anticoagulation prescription.29 It is usually balanced with the CHA2DS2-VASc Score (see above). The HAS-BLED pnemonic stands for hypertension, abnormal renal and liver function, stroke, bleeding, labile international normalised ratio (INR), elderly, and drugs or alcohol (see Table 12.15). Many of the online calculators space this out or change the order, but they pertain to the same parameters, which have weighted values between 0 and 2. The total score can range from 0–9, where a score of ≥3 denotes high risk of major bleeding, requiring regular review and some caution in prescription (see Table 12.16). It should be noted that there is some cross-over between the components of the CHA2DS2-VASc score and the HAS-BLED score, resulting often in a reflection of risk in both, and therefore a physician’s discretion and a patient’s preference contribute to decision making.
The relationship between H2FPEF and SYNTAX scores in patients with non-ST elevation myocardial infarction
Published in Acta Cardiologica, 2021
Emrah Bayam, Macit Kalçık, Burak Öztürkeri, Ersin Yıldırım, Ahmet Karaduman, Semih Kalkan, Ayhan Küp, Nuran Günay, Ahmet Güner, Muzaffer Kahyaoğlu, Cihangir Uyan
Besides several scoring systems developed especially for CAD patients, the risk scores developed for other conditions have been used for risk stratification in CAD. Kalyancuoglu et al. reported that CHA2DS2-VASc score may predict in-hospital mortality and MACE in patients undergoing isolated coronary artery bypass graft surgery [18]. Yildirim et al. claimed that the PRECISE-DAPT score was associated with high-degree atrioventricular block and atrial fibrillation in patients with STEMI undergoing percutaneous coronary intervention [19]. Konishi et al. declared that the HAS-BLED score could predict the risk of bleeding and mortality for patients who underwent percutaneous coronary intervention independent of the presence of atrial fibrillation [20]. To our best knowledge, this study is the first study to investigate the association of the H2FPEF score with SYNTAX score in NSTEMI patients. In our clinical study, SYNTAX score was found to be high in NSTEMI patients with high H2FPEF score. Although the H2FPEF score is used to determine HFpEF, it may help to determine the extent and complexity of CAD in NSTEMI patients.
Acute gastrointestinal bleeding among patients on antiplatelet and anticoagulant therapy after percutaneous coronary intervention
Published in Scandinavian Journal of Gastroenterology, 2021
Asdis Sveinsdottir, Ingibjörg J. Gudmundsdottir, Johann P. Hreinsson, Karl Andersen, Einar S. Björnsson
The use of antiplatelet and anticoagulation drugs must be balanced against their increased risk of gastrointestinal bleeding. Given that the incidence of GIB is low in these studies, the use of antiplatelet therapy in terms of AGIB seems to be relatively safe. The HAS-BLED score predicts the risk of gastrointestinal bleeding in patients on anticoagulation but it must be taken into account that risk of bleeding tends to go hand in hand with risk of thrombotic events for instance in patients with atrial fibrillation [18]. Bleeders were significantly older than non-bleeders which is in line with previous studies among unselected patients [19,20]. A NNH of 62 may be acceptable given the serious consequences of a potential thrombotic event. The current study demonstrated that only few bleeding events were life-threatening as only 19% (10/54) of those with AGIB required ICU stay. Furthermore, AGIB in three patients might have led to an earlier diagnosis of colon cancer due to bleeding associated with antiplatelet and anticoagulation therapy.
Utilization of percutaneous left atrial appendage closure in patients with atrial fibrillation: an update on patient outcomes
Published in Expert Review of Cardiovascular Therapy, 2020
Caroline Kleinecke, Steffen Gloekler, Bernhard Meier
Despite good stroke reduction, safety reasons and patient compliance limit the potential of lifelong OAC for stroke prevention: For example, only one-half of OAC eligible patients with AF are effectively treated with guideline recommended OAC [10]. Adherence to OAC is often deficient and dosing errors are not uncommon [11,12]. Especially in elderly patients, who are at highest risk for stroke and would benefit the most, an underuse of OAC is observed due to co-morbid factors like impaired cognition, history of falls and bleeding, renal or liver dysfunction and concomitant medications [13]. In the subset of patients with AF on chronic hemodialysis, OAC failed to lower the risk of thromboembolism, but was associated with an increased risk of bleeding (with exception of apixaban) [14]. The annual risk for major bleeding is 1.9–3.6% for NOACs, and of 3.1–4.2% for warfarin. Although NOACs have halved the risk of intracranial hemorrhage compared to VKAs, the risk of gastrointestinal bleeding remains similar or is higher [15–19]. The HAS-BLED score (hypertension, abnormal liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol) has been established for assessment of individual bleeding risks [20]. HAS-BLED scores >3 are regarded as high bleeding risk since they are associated with an incidence of major bleeding events of 5.8% per year [3].