Background Scores for cardio-embolic and bleeding risk in patients with atrial fibrillation are described in the literature. However, it is not clear how they co-classify elderly patients with multimorbidity, nor whether and how they affect the physician's decision on thromboprophylaxis. Methods Four scores for cardio-embolic and bleeding risks were retrospectively calculated for ≥ 65 year old patients with atrial fibrillation enrolled in the REPOSI registry. The co-classification of patients according to risk categories based on different score combinations was described and the relationship between risk categories tested. The association between the antithrombotic therapy received and the scores was investigated by logistic regressions and CART analyses. Results At admission, among 543 patients the median scores (range) were: CHADS2 2 (0–6), CHA2DS2–VASc 4 (1–9), HEMORR2HAGES 3 (0–7), HAS-BLED 2 (1–6). Most of the patients were at high cardio-embolic/high-intermediate bleeding risk (70.5% combining CHADS2 and HEMORR2HAGES, 98.3% combining CHA2DS2–VASc and HAS-BLED). 50–60% of patients were classified in a cardio-embolic risk category higher than the bleeding risk category. In univariate and multivariable analyses, a higher bleeding score was negatively associated with warfarin prescription, and positively associated with aspirin prescription. The cardio-embolic scores were associated with the therapeutic choice only after adjusting for bleeding score or age. Conclusion REPOSI patients represented a population at high cardio-embolic and bleeding risks, but most of them were classified by the scores as having a higher cardio-embolic than bleeding risk. Yet, prescription and type of antithrombotic therapy appeared to be primarily dictated by the bleeding risk.

Joint use of cardio-embolic and bleeding risk scorers in elderly patients with atrial fibrillation.

CAVALLO PERIN, Paolo;GRUDEN, Gabriella;BRUNO, Graziella;MONTRUCCHIO, Giuseppe;
2013

Abstract

Background Scores for cardio-embolic and bleeding risk in patients with atrial fibrillation are described in the literature. However, it is not clear how they co-classify elderly patients with multimorbidity, nor whether and how they affect the physician's decision on thromboprophylaxis. Methods Four scores for cardio-embolic and bleeding risks were retrospectively calculated for ≥ 65 year old patients with atrial fibrillation enrolled in the REPOSI registry. The co-classification of patients according to risk categories based on different score combinations was described and the relationship between risk categories tested. The association between the antithrombotic therapy received and the scores was investigated by logistic regressions and CART analyses. Results At admission, among 543 patients the median scores (range) were: CHADS2 2 (0–6), CHA2DS2–VASc 4 (1–9), HEMORR2HAGES 3 (0–7), HAS-BLED 2 (1–6). Most of the patients were at high cardio-embolic/high-intermediate bleeding risk (70.5% combining CHADS2 and HEMORR2HAGES, 98.3% combining CHA2DS2–VASc and HAS-BLED). 50–60% of patients were classified in a cardio-embolic risk category higher than the bleeding risk category. In univariate and multivariable analyses, a higher bleeding score was negatively associated with warfarin prescription, and positively associated with aspirin prescription. The cardio-embolic scores were associated with the therapeutic choice only after adjusting for bleeding score or age. Conclusion REPOSI patients represented a population at high cardio-embolic and bleeding risks, but most of them were classified by the scores as having a higher cardio-embolic than bleeding risk. Yet, prescription and type of antithrombotic therapy appeared to be primarily dictated by the bleeding risk.
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http://www.sciencedirect.com/science/article/pii/S0953620513009060
Elderly, Atrial fibrillation, Prediction guides, Bleeding risk, Cardioembolic risk, Thromboprophylaxis
Marcucci M; Nobili A; Tettamanti M; Iorio A; Pasina L; Djade CD; Franchi C; Marengoni A; Salerno F; Corrao S; Violi F; Mannucci PM; Pier MM; Nobili A; Tettamanti M; Pasina L; Franchi C; Salerno F; Corrao S; Marengoni A; Iorio A; Marcucci M; Spirito V; Noce D; Bonazzi J; Lombardo R; Sparacio E; Alborghetti S; Tettamanti M; De Vittorio L; Djade CD; Prisco D; Silvestri E; Cenci C; Barnini T; Delitala G; Carta S; Atzori S; Guarnieri G; Zanetti M; Spalluti A; Serra MG; Bleve MA; Vanoli M; Grignani G; Casella G; Gasbarrone L; Maniscalco G; Gunelli M; Tirotta D; Brucato A; Ghidoni S; Di Corato P; Bernardi M; Li Bassi S; Santi L; Agnelli G; Iorio A; Marcucci M; Marchesini E; Mannarino E; Lupattelli G; Rondelli P; Paciullo F; Fabris F; Carlon M; Turatto F; Baroni MC; Zardo M; Manfredini R; Molino C; Pala M; Fabbian F; Nuti R; Valenti R; Ruvio M; Cappelli S; Paolisso G; Rizzo MR; Laieta MT; Salvatore T; Sasso FC; Utili R; Durante Mangoni E; Pinto D; Olivieri O; Stanzial AM; Fellin R; Volpato S; Fotini S; Barbagallo M; Dominguez L; Plances L; D'Angelo D; Rini G; Mansueto P; Pepe I; Licata G; Calvo L; Valenti M; Borghi C; Strocchi E; Rinaldi ER; Zoli M; Fabbri E; Magalotti D; Auteri A; Pasqui AL; Puccetti L; Pasini FL; Capecchi PL; Bicchi M; Sabbà C; Vella FS; Marseglia A; Luglio CV; Palasciano G; Modeo ME; Aquilino A; Raffaele P; Pugliese S; Capobianco C; Postiglione A; Barbella MR; De Stefano F; Fenoglio L; Brignone C; Bracco C; Giraudo A; Musca G; Cuccurullo O; Cricco L; Fiorentini A; Cappellini MD; Fabio G; Seghezzi S; De Amicis MM; Fargion S; Bonara P; Bulgheroni M; Lombardi R; Magrini F; Massari F; Tonella T; Peyvandi F; Tedeschi A; Rossio R; Moreo G; Ferrari B; Roncari L; Monzani V; Savojardo V; Folli C; Magnini M; Mari D; Dionigi Rossi P; Damanti S; Prolo S; Lilleri MS; Cricco L; Fiorentini A; Micale G; Podda M; Selmi C; Meda F; Salerno F; Accordino S; Conca A; Monti V; Corazza GR; Miceli E; Lenti MV; Padula D; Balduini CL; Bertolino G; Provini S; Quaglia F; Murialdo G; Bovio M; Dallegri F; Ottonello L; Quercioli A; Barreca A; Secchi MB; Ghelfi D; Chin WS; Carassale L; Caporotundo S; Sofia L; Anastasio L; Carbone M; Traisci G; De Feudis L; Di Carlo S; Guagnano MT; Sestili S; Bergami E; Rizzioli E; Cagnoni C; Bertone L; Manucra A; Buratti A; Tognin T; Liberato NL; Bernasconi G; Nardo B; Bianchi GB; Giaquinto S; Benetti G; Quagliolo M; Centenaro GR; Purrello F; Di Pino A; Piro S; Mancuso G; Calipari D; Bartone M; Gullo F; Cortellaro M; Magenta M; Perego F; Meroni MR; Cicardi M; Magenta AG; Sacco A; Bonelli A; Dentamaro G; Rozzini R; Falanga L; Giordano A; Perin PC; Lorenzati B; Gruden G; Bruno G; Montrucchio G; Greco E; Tizzani P; Fera G; Di Luca ML; Renna D; Perciccante A; Coralli A; Tassara R; Melis D; Rebella L; Menardo G; Bottone S; Sferrazzo E; Ferri C; Striuli R; Scipioni R; Salmi R; Gaudenzi P; Gamberini S; Ricci F; Morabito C; Fava R; Semplicini A; Gottardo L; Delitala G; Carta S; Atzori S; Vendemiale G; Serviddio G; Forlano R; Bolondi L; Rasciti L; Serio I; Masala C; Mammarella A; Raparelli V; Rossi Fanelli F; Delfino M; Amoroso A; Violi F; Basili S; Perri L; Serra P; Fontana V; Falcone M; Landolfi R; Grieco A; Gallo A; Zuccalà G; Franceschi F; De Marco G; Chiara C; Marta S; Bellusci M; Setti D; Pedrazzoli F; Romanelli G; Pirali C; Amolini C; Rosei EA; Rizzoni D; Castoldi L; Picardi A; Gentilucci UV; Mazzarelli C; Gallo P; Guasti L; Castiglioni L; Maresca A; Squizzato A; Contini S; Molaro M; Annoni G; Zazzetta MC; Bertolotti M; Scotto CM; Ferri MA; Veltri F; Arturi F; Succurro E; Sesti G; Gualtieri U; Perticone F; Sciacqua A; Quero M; Bagnato C; Loria P; Becchi MA; Martucci G; Fantuzzi A; Maurantonio M; Corinaldesi R; De Giorgio R; Serra M; Grasso V; Ruggeri E; Carozza LM; Pignatti F.
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