HASBLED

[BobD]

Just some clarification regarding this. There is often a misconception that HASBLED can be used to negate CHADS2vasc2. It is (and this from the orginator some years ago) an aide memoir of things to consider and treat if possible before giving anticoagulants. It is not, in other words, a direct contra.

[mjames1]

Exactly, and thanks for posting

Unfortunately, however, it's an "aide memoir" (guide) that is not often considered when making the anticoagulant (or not) decision.

According to my CHADS alone, I'm a "3" and should be on thinners. (Although two of the points are for biological age and the other point is for 'controlled' hypertension, which some argue should not be a point, since controlled).

However, according to HASBLED, I am at high risk for bleeding, given my age (over 65) and prior history of anemia. And that doesn't even take into account some of my hobbies which arguably are high bleed risk.

The CHADS score is a great start point, But I find it unfortunate that with too many cardiologists and ep's it's also an end point.

According to decision on CHADS alone, Person "A" with zero afib episodes after their ablation, with controlled blood pressure, perfect bmi, who exercises regularly and eats well, yet has a high bleed risk per their vocation or hobby with a high HASBLED score -- will have the same CHADS score because they are treated exactly the same way as Person "B" who in perisistent 24/7 afib, with uncontrolled bp, morbidly obese, who exercises on the couch, eats badly and has a low Bleed Risk per vocation or hobby with a low HASBLED score.

Does this make any sense? Not to me Even though their CHADS score are the same, seems to me that Person "A" has a much better case of being off thinners than Person "B".

Jim

[waveylines in reply to mjames1]

Well said James. I'm a three too. One for for age, one for being a woman and one for controlled blood pressure (which was mild in any case and only take one low dose BP tablet) And don't do well on anticoag. High HASBLED score. Still on them though.... Half dose. Id love to see the research that proves the needs for anti coag on a score like mine.

[secondtry]

Yes good point and I think Jim's comments also relevant.

The trouble with CHADS is that it is a double edged sword - yes it is useful as a convenient understandably simple tool but because of its convenience & patient understanding medics use it more and more liberally without IMHO enough consideration of individual circumstances.

I am sure the medics would argue there isn't the time to look into it deeper and therefore I think the patient needs to do more homework and be a more active part of that decision.

[BobD Volunteer]

Some yearas ago I was AFA rep at a talk given by Prof Gregory Lip (The man who invented CHADS2VASC 2) to doctors and medical personel about anticoagulation and stroke prevention in AF.

He made the comment that doctors tended to be risk averse about prescribing anticoagulants with their biggest fear being GI (gastro intestinal ) bleeds. He stated that figures showed that should a GP have one patient with such they were ten times less likely to prescribe anticoagulants in the following year. He went on to say that no amount of thrombotic strokes would increase those doctors prescibing of the drug(s). Strange!

That was about ten or maybe twelve years ago when it was calculated that 8000 serious AF related strokes could be saved in UK if this mind set could be changed. Britain was the worst country in Europe for stroke prevention at that time.

Whilst there is still a lot of unreasonable resistance to anticoagulation in some quarters, thankfully things have improved though more needs to be done. I do know that most of the long standing members here consider their anticoagulant to be their best friend.

[RoyMacDonald]

I'm sad to say that I was one of the resistant ones until I had a major stroke that put me in the stroke unit. I could have avoided it had I listened to my GP. That piece of brain has gone now forever.

All the best.

Roy