Cardiovascular Critical Care I
Risk Assessment
Score
Total Patient
Score
Adjusted Annual
Stroke Rate, %
CHADS2
Congestive heart failure
1.9
Hypertension
2.8
Age ≥ 75
4.0
Diabetes
5.9
Stroke/TIA/thromboembolism
8.5
Maximum score
12.5
18.2
Risk Assessment
Score
Total Patient
Score
Adjusted Annual
Stroke Rate, %
CHA2DS2-VASc
Congestive heart failure
Hypertension
1.3
Age ≥ 75
2.2
Diabetes
3.2
Stroke/TIA/thromboembolism
4.0
Vascular disease
6.7
Age 65–74
9.8
Sex category (female)
9.6
Maximum score
6.7
15.2
AF = atrial fibrillation; TIA = transient ischemic attack.
Information from: January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American
College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2014;23:2071-104.
Anticoagulation decisions should balance the risk of stroke versus the risks of bleeding in the context
of duration of bridging and/or lack of anticoagulation. Scoring systems have been described to help
assess bleeding risk in anticoagulation decisions for patients with AF on warfarin anticoagulation
(Table 10). Not unlike stroke risk scoring systems, these scoring systems were not founded in the
context of critically ill patients.
Direct-acting oral anticoagulants (DOACs) are recommended over warfarin for patients with AF
J Am Coll Cardiol 2019;12:104-32).
| d. | For patients with AF who have a CHA2DS2-VASc score of 2 or greater (men) and 3 or greater |
|---|
(women) and who have end-stage chronic kidney disease (creatinine clearance [CrCl] less than
15 mL/minute/1.73 m2) or are receiving dialysis, it may be reasonable to prescribe warfarin (INR
2.0–3.0) or apixaban (J Am Coll Cardiol 2019;12:104-32).