The risk for bleeding during antithrombotic therapy for atrial fibrillation can be determined based on a number of clinical factors identified by the NCCCC as funded by NICE in the United Kingdom.
Patient selection: atrial fibrillation on warfarin/coumadin
(1) age of the patient in years
(2) therapy with antiplatelet drugs (aspirin or glycoprotein IIb/IIIa receptor antagonist) or NSAID
(3) uncontrolled hypertension
(4) history of bleeding or intracerebral hemorrhage (ICH)
(6) polypharmacy (multiple other medications)
(7) control of anticoagulation therapy
age of the patient
<= 75 years of age
> 75 years of age
therapy with antiplatelet drugs
history of bleeding
control of anticoagulation therapy
fair to good
• A history of bleeding can be assigned a higher point value because of increased risk.
• The impact of antiplatelet drugs and NSAIDS is affected by dose and other factors.
total number of risk factors =
= SUM(points for all 7 parameters)
• minimum number of risk factors: 0
• maximum number of risk factors: 7
• The greater the number of risk factors the greater the risk of bleeding.
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Purpose: To identify risk factors for bleeding in a patient taking oral anticoagulant therapy for atrial fibrillation based on the NICE guidelines.
Specialty: Hematology Oncology, Clinical Laboratory, Clinical Pharmacology
Objective: risk factors, severity, prognosis, stage