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Risk Factors for Bleeding During Antithrombotic Therapy from the NICE Guidelines for Atrial Fibrillation

Purpose: To identify risk factors for bleeding in a patient taking oral anticoagulant therapy for atrial fibrillation based on the NICE guidelines.

Description

The risk for bleeding during antithrombotic therapy for atrial fibrillation can be determined based on a number of clinical factors identified by the NCCCC as funded by NICE in the United Kingdom.


Patient selection: atrial fibrillation on warfarin/coumadin

Parameters:

(1) age of the patient in years

(2) therapy with antiplatelet drugs (aspirin or glycoprotein IIb/IIIa receptor antagonist) or NSAID

(3) uncontrolled hypertension

(4) history of bleeding or intracerebral hemorrhage (ICH)

(5) anemia

(6) polypharmacy (multiple other medications)

(7) control of anticoagulation therapy

 

Parameter

Finding

Points

age of the patient

<= 75 years of age

0

 

> 75 years of age

1

therapy with antiplatelet drugs

no

0

 

yes

1

uncontrolled hypertension

absent

0

 

present

1

history of bleeding

absent

0

 

present

1

anemia

absent

0

 

present

1

polypharmacy

absent

0

 

present

1

control of anticoagulation therapy

fair to good

0

 

poor

1

 

where:

• A history of bleeding can be assigned a higher point value because of increased risk.

• The impact of antiplatelet drugs and NSAIDS is affected by dose and other factors.

 

total number of risk factors =

= SUM(points for all 7 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 7

• The greater the number of risk factors the greater the risk of bleeding.


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Specialty

Objective

ICD-10