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Patient:
Date:
SPARC - Stroke Prevention in Atrial Fibrillation Risk Tool
for estimating risk of stroke and benefits & risks of antithrombotic therapy in patients with chronic atrial fibrillation        
references/notes
version 7, January 2015
Developed by Peter Loewen, ACPR, Pharm.D., FCSHP
peter.loewen@ubc.ca
In your patient with atrial fibrillation, which of the following stroke or bleeding risk factors are present? 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):
HAS-BLED CRITERIA*
Abnormal renal function (dialysis, SCr>200 mmol/L, or transplant)
Abnormal liver function (cirrhosis or liver enzymes >3x ULN)
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 these must be interpreted as "risk probably >10%".          
      PERCENT PER YEAR      
      Stroke / Embolism Major Bleeding         
    THERAPY CHADS2 CHA2DS2-VASc Pop.Avg. HAS-BLED        
    NO THERAPY          
    ASPIRIN           
    ASPIRIN+CLOP          
    WARFARIN        
    DABIGATRAN 110        
    DABIGATRAN 150        
    RIVAROXABAN        
    APIXABAN        
    EDOXABAN 30        
    EDOXABAN 60        
    percent per year          
[No canvas support]
                   
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
DETAILED RISK ESTIMATES          
                     
NO THERAPY
  Patient's ANNUAL risk of stroke+thrombosmbolism with
no antithrombotic therapy (CHADS2):
         
  Patient's ANNUAL risk of stroke+thrombosmbolism with
no antithrombotic therapy (CHA2DS2-VASc):
         
   ANNUAL risk of major bleed with no therapy  (population average): 0.6%          
  ASPIRIN 80-325mg/d          
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with aspirin (based on CHADS2):          
  Relative risk reduction: 22%            
Absolute risk reduction:
  Chance of benefit per year: 1 in            
  Patient's ANNUAL risk of ischemic stroke+thromboembolism 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. no therapy): 1 in 222            
  WARFARIN INR 2-3          
  Patient's ANNUAL risk of ischemic stroke+thromboembolism
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 ischemic stroke+thromboembolism
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):          
  Chance of being harmed by warfarin (per year, major bleeding, vs. no therapy): 1 in            
  Patient's ANNUAL risk of major bleed (HAS-BLED):          
  Chance of being harmed by warfarin (HAS-BLED) (per year, major bleeding, vs. no therapy):  1 in            
  ASPIRIN 75-100mg/d + CLOPIDOGREL 75mg/d          
  Patient's ANNUAL risk of ischemic stroke+thromboembolism 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 ischemic stroke+thromboembolism with aspirin + clopidogrel (based on CHA2DS2-VASc):          
  Relative risk reduction: 44%            
  Absolute risk reduction:            
  Chance of benefit per year: 1 in            
  Patient's ANNUAL risk of major bleed  (similar to warfarin, based on ACTIVE-W):          
  Chance of being harmed by ASA+clopidogrel (per year, major bleeding, vs. no therapy): 1 in            
  DABIGATRAN 110mg twice daily          
           
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with
dabigatran 110mg bid (based on CHADS2): 
         
  Relative risk reduction: 66%            
  Absolute risk reduction:            
  Chance of benefit per year: 1 in            
  Patient's ANNUAL risk of ischemic stroke+thromboembolism
with dabigatran 110bid (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., 20% less than warfarin):          
  Chance of being harmed by dabigatran 110 mg bid (per year, major bleeding, vs. no therapy): 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. no therapy): 1 in             
  DABIGATRAN 150mg twice daily          
           
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with
dabigatran 150 mg bid (based on CHADS2):
         
  Relative risk reduction: 79%            
  Absolute risk reduction:            
  Chance of benefit per year: 1 in            
  Patient's ANNUAL risk of ischemic stroke+thromboembolism
with dabigatran 150bid (based on CHA2DS2-VASc):
         
  Relative risk reduction: 79%            
  Absolute risk reduction:            
  Chance of benefit per year: 1 in            
  ANNUAL risk of major bleed (population avg):          
  Chance of being harmed by dabigatran 150 mg bid (per year, major bleeding, vs. no therapy): 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. no therapy 1 in            
  RIVAROXABAN 20mg once daily          
           
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with
rivaroxaban (based on CHADS2):
         
  Relative risk reduction:            
  Absolute risk reduction:            
  Chance of benefit per year: 1 in            
  Patient's ANNUAL risk of ischemic stroke+thromboembolism
with rivaroxaban (based on CHA2DS2-VASc):
         
  Relative risk reduction:            
  Absolute risk reduction:            
  Chance of benefit per year: 1 in            
  ANNUAL risk of major bleed (population avg):          
  Chance of being harmed by rivaroxaban (per year, major bleeding, vs. no therapy): 1 in             
  Patient's ANNUAL risk of major bleed (HAS-BLED):          
  Chance of being harmed by rivaroxaban (per year, major bleeding, vs. no therapy): 1 in             
  APIXABAN 5mg twice daily          
           
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with
apixaban (based on CHADS2):
         
Relative risk reduction: 74%
Absolute risk reduction:
Chance of benefit per year: 1 in
  Patient's ANNUAL risk of ischemic stroke+thromboembolism
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 (population avg, 31% less than warfarin):          
  Chance of being harmed by apixaban (per year, major bleeding, vs. no therapy): 1 in             
  Patient's ANNUAL risk of major bleed (HAS-BLED):          
  Chance of being harmed by apixaban (per year, major bleeding, vs. no therapy): 1 in             
  EDOXABAN 30mg once daily          
           
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with
edoxaban (based on CHADS2):
         
Relative risk reduction: 66%
Absolute risk reduction:
Chance of benefit per year: 1 in
  Patient's ANNUAL risk of ischemic stroke+thromboembolism
with edoxaban (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, 53% less than warfarin):          
  Chance of being harmed by edoxaban (per year, major bleeding, vs. no therapy): 1 in             
  Patient's ANNUAL risk of major bleed (HAS-BLED):          
  Chance of being harmed by edoxaban (per year, major bleeding, vs. no therapy):  similar to population avg. (0.6%)          
  EDOXABAN 60mg once daily          
           
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with
edoxaban (based on CHADS2):
         
Relative risk reduction: 66%
Absolute risk reduction:
Chance of benefit per year: 1 in
  Patient's ANNUAL risk of ischemic stroke+thromboembolism
with edoxaban (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, 20% less than warfarin):          
  Chance of being harmed by edoxaban (per year, major bleeding, vs. no therapy): 1 in             
  Patient's ANNUAL risk of major bleed (HAS-BLED):          
  Chance of being harmed by edoxaban (per year, major bleeding, vs. no therapy): 1 in