CHA2DS2-VASc: Risk for Intracranial hemorrhage vs risk for embolicstroke
Figure 12 illustrates some data that support the ESC treatment consensus statement from the previous Figure.[9] The data come from the large Swedish Atrial Fibrillation Cohort.[10] The graph in the upper left-hand corner is the most instructive: the 2 curves represent the net clinical benefit for patients with a CHA2DS2-VASc stroke-risk score of 0–2 (actually closer to 1–2), ie, the group with AFib but the lowest risk of stroke and a HAS-BLED bleeding-risk score of ≥3 (the vertical ordinate), ie, patients with AFib and a high risk of bleeding.
In other words, in these patients with a low risk of stroke and a high risk of bleeding, physicians will surely ask, "Do I really want to be given oral anticoagulant therapy here?"
Nevertheless, the “proportion surviving” curves (the y-axis) show that out to 4 years (the x-axis) there is a highly statistically significant (P<.00001) increase in probability of survival for the patients on oral anticoagulation therapy, even in this group of patients.
References
Lip GYH, Andreotti F, Fauchier L, et al. Bleeding risk assessment and management in atrial fibrillation patients: a position document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis. Europace. 2011;13:723-746.
Friberg L, Rosenqvist M, Lip GY. Net clinical benefit of warfarin in patients with atrial fibrillation: a report from the Swedish Atrial Fibrillation Cohort study. Circulation. 2011;125:2298-2307.