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Review

Fall risk and anticoagulation for atrial fibrillation in the elderly: A delicate balance

Tracy Hagerty, MD and Michael W. Rich, MD
Cleveland Clinic Journal of Medicine January 2017, 84 (1) 35-40; DOI: https://doi.org/10.3949/ccjm.84a.16016
Tracy Hagerty
Fellow in Cardiology, Washington University School of Medicine, St. Louis, MO
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Michael W. Rich
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  • For correspondence: [email protected]
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    TABLE 1

    Annual risk of stroke based on CHADS2 or CHA2DS2-VASc score

    ScoreCHADS211CHA2DS2-VASc12
    0  1.9%  0.0%
    1  2.8%  1.3%
    2  4.0%  2.2%
    3  5.9%  3.2%
    4  8.5%  4.0%
    512.5%  6.7%
    618.2%  9.8%
    7—  9.6%
    8—12.5%
    9—15.2%
    • CHADS2: 1 point each for congestive heart failure, hypertension, age ≥ 75, diabetes mellitus; 2 points for prior stroke or transient ischemic attack.

    • CHA2DS2-VASc: 1 point each for congestive heart failure, hypertension, age 65–74, diabetes mellitus, vascular disease (coronary artery disease, peripheral arterial disease, aortic aneurysm), sex category female; 2 points for age ≥ 75 and for prior stroke or transient ischemic attack.

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    TABLE 2

    Scores to predict bleeding on anticoagulation therapy

    HAS-BLED14PointsHEMORR2HAGES15PointsATRIA16Points
    Hypertension  1Hepatic or renal abnormality  1Anemia  3
    Abnormal renal function  1Ethanol abuse  1Severe renal disease  3
    Abnormal liver function  1Malignancy  1Age ≥ 75  2
    Stroke  1Older age (> 75)  1Prior bleed  1
    Bleeding history  1Reduced platelet function  1Hypertension  1
    Labile INR  1Rebleeding risk  2
    Elderly (age > 65)  1Hypertension (uncontrolled)  1
    Drugs  1Anemia  1
    Alcohol  1Genetic factors  1
    Excessive falls  1
    Stroke  1
    Maximum score  9Maximum score12Maximum score10
    • ATRIA = Anticoagulation and Risk Factors in Atrial Fibrillation study16; INR = international normalized ratio

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Cleveland Clinic Journal of Medicine: 84 (1)
Cleveland Clinic Journal of Medicine
Vol. 84, Issue 1
1 Jan 2017
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Fall risk and anticoagulation for atrial fibrillation in the elderly: A delicate balance
Tracy Hagerty, Michael W. Rich
Cleveland Clinic Journal of Medicine Jan 2017, 84 (1) 35-40; DOI: 10.3949/ccjm.84a.16016

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Fall risk and anticoagulation for atrial fibrillation in the elderly: A delicate balance
Tracy Hagerty, Michael W. Rich
Cleveland Clinic Journal of Medicine Jan 2017, 84 (1) 35-40; DOI: 10.3949/ccjm.84a.16016
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  • Article
    • ABSTRACT
    • AGE, ATRIAL FIBRILLATION, AND STROKE RISK
    • BALANCING STROKE RISK VS BLEEDING RISK
    • FALLS AND ANTICOAGULATION
    • AT WHAT POINT DOES BLEEDING RISK OUTWEIGH ANTICOAGULATION BENEFIT?
    • SHOULD OUR PATIENT RECEIVE ANTICOAGULATION?
    • A COMPLEX DECISION
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  • Anticoagulation for atrial fibrillation (January 2017)
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