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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 6.21, March 2013
    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
    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 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        
        percent per year          
    Unable to load Flash content. The Charts Control requires Flash Player 9.0.45 or higher. You can download the latest version of Flash Player from the Adobe Flash Player Download Center
     
                       
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
                         
    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