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Patient:
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Date:
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SPARC
- Stroke Prevention in Atrial Fibrillation Risk Calculator
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for estimating risk of stroke and
benefits & risks of antithrombotic therapy in patients with chronic
atrial fibrillation
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version
5.2, September 2011
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Developed
by Peter Loewen, ACPR, Pharm.D., FCSHP [ploewen@interchange.ubc.ca]
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In your patient with atrial fibrillation,
which of the following stroke or bleeding risk factors are present? (click check boxes)
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CHADS2
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CHADS-VASc
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HAS-BLED
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?
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CHADS2 CRITERIA
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CHF/LV
dysfunction (diagnosed at any time in the past)
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Hypertension
(controlled or uncontrolled)
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Age
> 75
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Diabetes
(Type I or II) controlled or uncontrolled
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TIA
or stroke at any time in the past
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CHADS2 SCORE (0-6):
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?
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CHA2DS2-VASc CRITERIA*
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Prior MI, peripheral artery
disease, or aortic plaque
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Age 65-75
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Female
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CHA2DS2-VASc SCORE (0-9):
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*CHA2DS2-VASc has similar or
possibly slightly better predictive performance than CHADS2. [BMJ
2011;342:d124 doi:10.1136/bmj.d124].
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?
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HAS-BLED CRITERIA**
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Abnormal renal function
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Abnormal liver function
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History of major bleeding
(any cause)
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History of labile INR (time
in therapeutic range <60%)
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Current "excess"
use of alcohol
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Currently taking antiplatelet
drug(s) or NSAID(s)
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HAS-BLED SCORE (0-9)**:
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**no studies have observed major
bleeding in patients with score>5, so scores >5 must be interpreted as
"risk probably >10%". HAS-BLED has not been well validated, but
its use is recommended in some AF guidelines.
Shown to have poor predictive power. HAS-BLED bleeding risks should be
interpreted with extreme caution.
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NO THERAPY:
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Patient's
ANNUAL risk of ischemic stroke with
no antithrombotic therapy (CHADS2):
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?
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Patient's
ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or
peripheral embolism with
no antithrombotic therapy (CHA2DS2-VASc):
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ANNUAL risk of major bleed (population
average):
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ASPIRIN
80-325mg/d:
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Patient's
ANNUAL risk of ischemic stroke with aspirin (based on CHADS2):
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?
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Relative risk reduction:
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22%
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Absolute risk reduction:
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Chance of benefit per year: 1
in
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Patient's
ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or
peripheral embolism with aspirin (based on CHA2DS2-VASc):
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Relative risk reduction:
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22%
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Absolute risk reduction:
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Chance of benefit per year: 1
in
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ANNUAL risk of major bleed
(population avg):
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1.1%
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Chance
of being harmed by aspirin (per year, major bleeding, vs. placebo): 1 in
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222
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WARFARIN INR 2-3:
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Patient's
ANNUAL risk of ischemic stroke
with warfarin INR 2-3 (based on CHADS2):
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?
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Relative risk reduction:
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66%
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Absolute risk reduction:
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Chance of benefit per year: 1
in
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Patient's
ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or
peripheral embolism
with warfarin INR 2-3 (based on CHA2DS2-VASc):
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Relative risk reduction:
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66%
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Absolute risk reduction:
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Chance of benefit per year: 1
in
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ANNUAL risk of major bleed
(population avg):
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2.4-2.8%
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Chance
of being harmed by warfarin (per year, major bleeding, vs. placebo): 1 in
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Patient's ANNUAL risk of
major bleed (HAS-BLED):
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Chance
of being harmed by warfarin (HAS-BLED) 1 in
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ASPIRIN 75-100mg/d +
CLOPIDOGREL 75mg/d:
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Patient's
ANNUAL risk of ischemic stroke with
aspirin + clopidogrel (based on CHADS2):
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?
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Relative risk reduction:
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44%
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Absolute risk reduction:
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Chance of benefit per year: 1
in
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Patient's
ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or
peripheral embolism
with warfarin INR 2-3 (based on CHA2DS2-VASc):
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Relative risk reduction:
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66%
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Absolute risk reduction:
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Chance of benefit per year: 1
in
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Chance
of being harmed by ASA+clopidogrel (per year, major bleeding, vs. placebo): 1
in
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Patient's ANNUAL risk of
major bleed (HAS-BLED):
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Chance
of being harmed by ASA+clopidogrel (per year, major bleeding, vs. placebo): 1
in
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DABIGATRAN 110mg twice daily:
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Patient's
ANNUAL risk of ischemic stroke with
dabigatran 110mg bid:
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similar to warfarin
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Relative risk reduction:
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66%
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Absolute risk reduction:
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Chance of benefit per year: 1
in
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Patient's
ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or
peripheral embolism
with dabigatran 110bid (based on CHA2DS2-VASc):
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similar to warfarin
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Relative risk reduction:
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66%
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Absolute risk reduction:
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Chance of benefit per year: 1
in
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ANNUAL risk of major bleed
(RE-LY trial):
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2.71% (20% less than warfarin)
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Chance
of being harmed by dabigatran 110 mg bid (per year, major bleeding, vs.
placebo): 1 in
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Patient's ANNUAL risk of
major bleed (HAS-BLED):
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Chance
of being harmed by dabigatran 110 mg bid (per year, major bleeding, vs.
placebo): 1 in
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DABIGATRAN 150mg twice daily:
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Patient's
ANNUAL risk of ischemic stroke with
dabigatran 150 mg bid (based on CHADS2):
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?
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Relative risk reduction:
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78%
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Absolute risk reduction:
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Chance of benefit per year:
1 in
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Patient's
ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or
peripheral embolism
with dabigatran 150bid (based on CHA2DS2-VASc):
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Relative risk reduction:
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78%
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Absolute risk reduction:
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Chance of benefit per year:
1 in
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ANNUAL risk of major bleed
(population avg):
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similar to warfarin
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Chance
of being harmed by dabigatran 150 mg bid (per year, major bleeding, vs.
placebo): 1 in
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Patient's ANNUAL risk of
major bleed (HAS-BLED):
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Chance
of being harmed by dabigatran 150 mg bid (per year, major bleeding, vs.
placebo): 1 in
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RIVAROXABAN 20mg once daily:
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Patient's
ANNUAL risk of ischemic stroke with
rivaroxaban (based on CHADS2):
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?
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Relative risk reduction:
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74%
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Absolute risk reduction:
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Chance of benefit per year:
1 in
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Patient's
ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or
peripheral embolism
with rivaroxaban (based on CHA2DS2-VASc):
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Relative risk reduction:
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74%
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Absolute risk reduction:
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Chance of benefit per year:
1 in
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ANNUAL risk of major bleed
(population avg):
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similar to warfarin
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Chance
of being harmed by rivaroxaban (per year, major bleeding, vs. placebo): 1
in
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Patient's ANNUAL risk of
major bleed (HAS-BLED):
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Chance
of being harmed by rivaroxaban (per year, major bleeding, vs. placebo): 1
in
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APIXABAN 5mg twice daily:
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Patient's
ANNUAL risk of ischemic stroke with
apixaban (based on CHADS2):
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?
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Relative risk reduction:
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74%
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Absolute risk reduction:
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Chance of benefit per year:
1 in
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Patient's
ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or
peripheral embolism
with apixaban (based on CHA2DS2-VASc):
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Relative risk reduction:
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74%
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Absolute risk reduction:
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Chance of benefit per year:
1 in
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ANNUAL risk of major bleed
(ARISTOTLE Trial)
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2.1% (31% less than warfarin)
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Chance
of being harmed by apixaban (per year, major bleeding, vs. placebo): 1
in
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Patient's ANNUAL risk of
major bleed (HAS-BLED):
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Chance
of being harmed by apixaban (per year, major bleeding, vs. placebo): 1
in
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