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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 v.8.2, Sept 2017 notes/references
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 expressed or implied, regarding this tool. 
 In your patient with atrial fibrillation, which of the following stroke or bleeding risk factors are present?
Stroke Risk (CHA2DS2-VASc)
CHA2DS2-VASc SCORE (0-9):
Major Bleeding Risk (HAS-BLED)
HAS-BLED SCORE (0-9):
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
ASA
Warfarin
ASA+Clop
Dabig110
Dabig150
Rivaroxaban
Apixaban
Edox30
Edox60
 NO THERAPY
Patient's ANNUAL risk of ischemic 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):
 ASPIRIN 80-325mg/d
Patient's ANNUAL risk of ischemic stroke+thromboembolism with aspirin: 
Relative risk reduction:
Absolute risk reduction:
Chance of benefit per year:
ANNUAL risk of major bleed (population avg):
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:
Absolute risk reduction:
Chance of benefit per year:
ANNUAL risk of major bleed (population avg):
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:
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:
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:
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:
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 once daily:
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 once 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 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):
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