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    SPARC - Stroke Prevention in Atrial Fibrillation Risk Calculator
    for estimating risk of stroke and benefits & risks of antithrombotic therapy in patients with chronic atrial fibrillation
    version 5.2, September 2011
    Developed by Peter Loewen, ACPR, Pharm.D., FCSHP [ploewen@interchange.ubc.ca]
    In your patient with atrial fibrillation, which of the following stroke or bleeding risk factors are present? (click check boxes) CHADS2 CHADS-VASc HAS-BLED
    ? CHADS2 CRITERIA
    CHF/LV dysfunction (diagnosed at any time in the past)
    Hypertension (controlled or uncontrolled)
    Age > 75
    Diabetes (Type I or II) controlled or uncontrolled
    TIA or stroke at any time in the past
    CHADS2 SCORE (0-6):
    ? CHA2DS2-VASc CRITERIA*
    Prior MI, peripheral artery disease, or aortic plaque
    Age 65-75
    Female
    CHA2DS2-VASc SCORE (0-9):
    *CHA2DS2-VASc has similar or possibly slightly better predictive performance than CHADS2. [BMJ 2011;342:d124 doi:10.1136/bmj.d124].
    ? HAS-BLED CRITERIA**
    Abnormal renal function
    Abnormal liver function
    History of major bleeding (any cause)
    History of labile INR (time in therapeutic range <60%)
    Current "excess" use of alcohol
    Currently taking antiplatelet drug(s) or NSAID(s)
    HAS-BLED SCORE (0-9)**:
    **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.
    NO THERAPY:
    Patient's ANNUAL risk of ischemic stroke with
    no antithrombotic therapy (CHADS2):     		?
    Patient's ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or peripheral embolism with
    no antithrombotic therapy (CHA2DS2-VASc):
    ANNUAL risk of major bleed (population average):
    ASPIRIN 80-325mg/d:
    Patient's ANNUAL risk of ischemic stroke with aspirin (based on CHADS2): ?
    Relative risk reduction: 22%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    Patient's ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or peripheral embolism with aspirin (based on CHA2DS2-VASc):
    Relative risk reduction: 22%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    ANNUAL risk of major bleed (population avg): 1.1%
    Chance of being harmed by aspirin (per year, major bleeding, vs. placebo): 1 in 222
    WARFARIN INR 2-3:
    Patient's ANNUAL risk of ischemic stroke
    with warfarin INR 2-3 (based on CHADS2):     		?
    Relative risk reduction: 66%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    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):
    Relative risk reduction: 66%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    ANNUAL risk of major bleed (population avg): 2.4-2.8%
    Chance of being harmed by warfarin (per year, major bleeding, vs. placebo): 1 in
    Patient's ANNUAL risk of major bleed (HAS-BLED):
    Chance of being harmed by warfarin (HAS-BLED) 1 in
    ASPIRIN 75-100mg/d + CLOPIDOGREL 75mg/d:
    Patient's ANNUAL risk of ischemic stroke with
    aspirin + clopidogrel (based on CHADS2):     		?
    Relative risk reduction: 44%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    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):
    Relative risk reduction: 66%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    Chance of being harmed by ASA+clopidogrel (per year, major bleeding, vs. placebo): 1 in
    Patient's ANNUAL risk of major bleed (HAS-BLED):
    Chance of being harmed by ASA+clopidogrel (per year, major bleeding, vs. placebo): 1 in
    DABIGATRAN 110mg twice daily:
    Patient's ANNUAL risk of ischemic stroke with
    dabigatran 110mg bid:     		similar to warfarin ?
    Relative risk reduction: 66%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    Patient's ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or peripheral embolism
    with dabigatran 110bid (based on CHA2DS2-VASc):     		similar to warfarin
    Relative risk reduction: 66%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    ANNUAL risk of major bleed (RE-LY trial): 2.71% (20% less than warfarin)
    Chance of being harmed by dabigatran 110 mg bid (per year, major bleeding, vs. placebo): 1 in
    Patient's ANNUAL risk of major bleed (HAS-BLED):
    Chance of being harmed by dabigatran 110 mg bid (per year, major bleeding, vs. placebo): 1 in
    DABIGATRAN 150mg twice daily:
    Patient's ANNUAL risk of ischemic stroke with
    dabigatran 150 mg bid (based on CHADS2):     		?
    Relative risk reduction: 78%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    Patient's ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or peripheral embolism
    with dabigatran 150bid (based on CHA2DS2-VASc):
    Relative risk reduction: 78%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    ANNUAL risk of major bleed (population avg): similar to warfarin
    Chance of being harmed by dabigatran 150 mg bid (per year, major bleeding, vs. placebo): 1 in
    Patient's ANNUAL risk of major bleed (HAS-BLED):
    Chance of being harmed by dabigatran 150 mg bid (per year, major bleeding, vs. placebo): 1 in
    RIVAROXABAN 20mg once daily:
    Patient's ANNUAL risk of ischemic stroke with
    rivaroxaban (based on CHADS2):     		?
    Relative risk reduction: 74%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    Patient's ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or peripheral embolism
    with rivaroxaban (based on CHA2DS2-VASc):
    Relative risk reduction: 74%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    ANNUAL risk of major bleed (population avg): similar to warfarin
    Chance of being harmed by rivaroxaban (per year, major bleeding, vs. placebo): 1 in
    Patient's ANNUAL risk of major bleed (HAS-BLED):
    Chance of being harmed by rivaroxaban (per year, major bleeding, vs. placebo): 1 in
    APIXABAN 5mg twice daily:
    Patient's ANNUAL risk of ischemic stroke with
    apixaban (based on CHADS2):     		?
    Relative risk reduction: 74%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    Patient's ANNUAL risk of hospitalization or death due to ischemic stroke, PE, or peripheral embolism
    with apixaban (based on CHA2DS2-VASc):
    Relative risk reduction: 74%
    Absolute risk reduction:
    Chance of benefit per year: 1 in
    ANNUAL risk of major bleed (ARISTOTLE Trial) 2.1% (31% less than warfarin)
    Chance of being harmed by apixaban (per year, major bleeding, vs. placebo): 1 in
    Patient's ANNUAL risk of major bleed (HAS-BLED):
    Chance of being harmed by apixaban (per year, major bleeding, vs. placebo): 1 in