Oral Anticoagulation and the Novel Oral Anticoagulants (NOACs):Where Are We at Midterm?

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Program Overview

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Introduction Deepak L. Bhatt Elaine Hylek

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Deepak L. Bhatt, MD, MPH
Interventional Cardiovascular Programs
Brigham & Women’s Hospital
Heart & Vascular Center
Harvard Medical School
Boston, Massachusetts

Overview: Anticoag & NOACs AFib Impact AFib in the USA AFib: Age Prevalence AFib: Age & Gender AFib: Age & Strokes Problems with Warfarin Warfarin INR Values & Stroke CHADS2 & AFib - Index Scores CHADS2 & AFib - Patient Scores The REACH Registry: CVD Events CHA2DS2-VASc Stroke Risk The HAS-BLED Risk Score Markov Decision Analysis Novel Oral Anticoagulants NOACS: Risk Prevention Data NOACS: Secondary Efficacy NOACS: Major Bleeding NOACS: Secondary Safety Potentially Preventable Strokes Anticoagulation in VTE Regulatory Approval Status

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The CHADS2 Stroke Risk Score in Patients with AFib: Index Score Points and Disease Prevalence

To optimize the appropriate use of warfarin, or anticoagulation in general, several risk scores have been developed to calculate the risk of stroke in patients with AFib.[8] A premier example is CHADS2 risk score, which is an algorithm that assigns index points to different risk factors. As shown in Figure 9, the letters C-H-A-D-S- stand, respectively, for congestive heart failure, hypertension, age >75 years, diabetes mellitus, and stroke or transient ischemic attack (TIA).[9] The first four elements are given 1 point, whereas stroke or TIA, conferring the highest risk of a future stroke, is assigned 2 points. Thus on the CHADS2 score the maximum number of points would be 6 and the minimum would be 0.

Bhatt D. Am J Med 2014; 00.

References

[8]

van Walraven C, Hart RG, Wells GA, et al. A clinical prediction rule to identify patients with atrial fibrillation and a low risk for stroke while taking aspirin. Arch Intern Med. 2003;163:936-943.

[9]

Nieuwlaat R, Capucci A, Lip GY, et al; Euro Heart Survey Investigators. Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation. Eur Heart J. 2006;27:3018-3026.