To weigh the risks and benefits of anticoagulation in patients with atrial fibrillation, use two validated tools, the CHA2DS2-VASc score, and the HAS-BLED score.
A CHAD2DS2-VASc of ≥ 2 argues for anticoagulation and a HAS-BLED score of ≥ 3 argues against anticoagulation.
“The European Society of Cardiology 2016 Guidelines for Atrial Fibrillation state that the benefits of oral anticoagulation outweigh the risks in the majority of patients with atrial fibrillation who meet CHA2DS2-VASc criteria for oral anticoagulation. This includes the elderly and patients with cognitive impairment, frailty, or frequent falling. Oral anticoagulation is superior to aspirin for the prevention of stroke, while the bleeding risk with aspirin is not different than that of oral anticoagulation.
Use of the CHA2DS2-VASc criteria significantly increases the number of patients eligible for anticoagulation therapy compared with the CHADS2 scoring system.
If there is concern about bleeding risk, particularly in patients older than 65 years of age, the HAS-BLED scoring system has been well validated, with a score of 3 or more indicating that a patient has a high likelihood of hemorrhage.”ABFM critique.