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  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      
  Developed by Peter Loewen, ACPR, Pharm.D., FCSHP peter.loewen@ubc.ca        
  references/notes   version 8.1, June 2016        
DISCLAIMER:  this tool may be used unaltered for learning purposes and the author assumes no responsibility whatsoever for any decisions or harms to anyone resulting from its use. The author makes no representations, conditions or warranties, either express or implied, regarding this tool.     
  Patient:                  
  Date:          
  In your patient with atrial fibrillation, which of the following stroke or bleeding risk factors are present?    
Stroke Risk (CHA2DS2-VASc)
  Age  
     
TIA or stroke
(at any time in the past)
CHF/LV dysfunction
(diagnosed at any time in the past)
Prior MI, peripheral artery disease, or aortic plaque
Hypertension
(controlled or uncontrolled)
Female
Diabetes Type I or II
(controlled or uncontrolled)
CHA2DS2-VASc SCORE (0-9): 
Major Bleeding Risk (HAS-BLED*)
  Abnormal renal function
(dialysis, SCr>200 mcmol/L, or transplant)
History of labile INR
(time in therapeutic range <60%)
 
  Hypertension
(SBP>160mmHg)
Current use of alcohol
(>8 drinks per week)
 
  Abnormal liver function
(cirrhosis or liver enzymes >3x ULN)
Currently taking antiplatelet drug or NSAID
 
  History of major bleeding
(any cause)
HAS-BLED SCORE (0-9):     
Which therapy options to HIDE?        
Aspirin
Dabigatran
Aspirin+Clopidogrel
Rivaroxaban Hide individual charts
Warfarin
Apixaban Hide stroke/bleed chart
Edoxaban
      PERCENT PER YEAR        
        annual risk of stroke/embolism  annual risk of major bleeding (intracranial bleeding, bleeding requiring hospitalization, HgB decrease of > 20 g/L, or need for transfusion secondary to bleeding)      
      NO THERAPY        
      ASPIRIN         
      ASPIRIN+CLOP        
      WARFARIN      
      DABIGATRAN 110      
      DABIGATRAN 150      
      RIVAROXABAN      
      APIXABAN      
      EDOXABAN 30      
      EDOXABAN 60      
Stroke/Embolism (% per year)   Major Bleeding (% per year)          
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Stroke/Embolism (blue) and Major Bleeding (red) (% per year)            
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DETAILED RISK ESTIMATES        
   NO THERAPY        
  Patient's annual risk of stroke+thromboembolism with no therapy:        
  Patient's annual risk of stroke or TIA with no therapy if they did NOT have AF (for comparison):        
   Annual risk of major bleed with no therapy (population average, not individualized): 0.6%        
   ASPIRIN 80-325mg/d        
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with aspirin:        
  Relative risk reduction: 22%          
  Absolute risk reduction:          
  Chance of benefit per year:          
  ANNUAL risk of major bleed (population avg, not individualized): 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:        
  Relative risk reduction: 66%          
  Absolute risk reduction:          
  Chance of benefit per year:          
  ANNUAL risk of major bleed (population avg, not individualized):        
  Chance of being harmed by warfarin (per year, major bleeding, vs. no therapy):          
  Patient's ANNUAL risk of major bleed (HAS-BLED):      
  Chance of being harmed by warfarin (HAS-BLED) (per year, major bleeding, vs. no therapy):            
   ASPIRIN 75-100mg/d + CLOPIDOGREL 75mg/d        
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with aspirin + clopidogrel:        
  Relative risk reduction: 44%          
  Absolute risk reduction:          
  Chance of benefit per year:          
  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):          
   DABIGATRAN 110mg twice daily        
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with dabigatran 110mg twice daily:         
  Relative risk reduction: 66%          
  Absolute risk reduction:          
  Chance of benefit per year:          
  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):          
  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):          
   DABIGATRAN 150mg twice daily        
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with dabigatran 150mg twice daily:        
  Relative risk reduction: 79%          
  Absolute risk reduction:          
  Chance of benefit per year:          
ANNUAL risk of major bleed (population avg):
  Chance of being harmed by dabigatran 150 mg bid (per year, major bleeding, vs. no therapy):        
  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:        
   RIVAROXABAN 20mg once daily        
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with rivaroxaban:        
  Relative risk reduction:          
  Absolute risk reduction:          
  Chance of benefit per year:          
  ANNUAL risk of major bleed (population avg):        
  Chance of being harmed by rivaroxaban (per year, major bleeding, vs. no therapy):          
  Patient's ANNUAL risk of major bleed (HAS-BLED):        
  Chance of being harmed by rivaroxaban (per year, major bleeding, vs. no therapy):          
   APIXABAN 5mg twice daily        
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with apixaban:        
Relative risk reduction: 74%
Absolute risk reduction:
Chance of benefit per year:
  ANNUAL risk of major bleed (population avg, 31% less than warfarin):        
  Chance of being harmed by apixaban (per year, major bleeding, vs. no therapy):          
Patient's ANNUAL risk of major bleed (HAS-BLED):
  Chance of being harmed by apixaban (per year, major bleeding, vs. no therapy):          
   EDOXABAN 30mg once daily        
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with edoxaban 30mg:        
Relative risk reduction: 66%
Absolute risk reduction:
Chance of benefit per year:
  ANNUAL risk of major bleed (population avg, 53% less than warfarin):        
  Chance of being harmed by edoxaban (per year, major bleeding, vs. no therapy):          
Patient's ANNUAL risk of major bleed (HAS-BLED):
  Chance of being harmed by edoxaban (per year, major bleeding, vs. no therapy):         
   EDOXABAN 60mg once daily        
  Patient's ANNUAL risk of ischemic stroke+thromboembolism with edoxaban 60mg:        
Relative risk reduction: 66%
Absolute risk reduction:
Chance of benefit per year:
  ANNUAL risk of major bleed (population avg, 20% less than warfarin):        
  Chance of being harmed by edoxaban (per year, major bleeding, vs. no therapy):          
Patient's ANNUAL risk of major bleed (HAS-BLED):
  Chance of being harmed by edoxaban (per year, major bleeding, vs. no therapy):