Comparing CHADS VASC and HAS BLED?

The risk of bleeding versus the risk of clotting must always be weighed when starting or stopping a patient on anticoagulation. It can be kind of vague and theoretical, and multiple scoring systems have been developed to serve as clinical decision-making tools. Two of these are CHADS VASC (which measures risk of stroke in someone with a fib) and HAS-BLED (measures risk of bleeding in any patient started on anticoagulation.

You can’t compare any two scores directly. It’s not as though a higher CHADS VASC score “outweighs” a HAS-BLED score and thus anticoagulation should be continued. 

It has been reported that HAS-BLED is more accurate in predicting risk for its group of patients. However as this paper states, HAS-BLED should not be used on its own to exclude patients from antocoagulation therapy; it allows the clinician to identify bleeding risk factors and to correct those that are modifiable, ie, by controlling blood pressure, removing concomitant antiplatelet or nonsteroidal antiinflammatory drugs, and counseling the patient about reducing alcohol intake (if excessive). 

“Thus, bleeding risk assessment with HAS-BLED should not be used as an excuse not to prescribe OAC but rather to highlight those patients in whom caution with such treatment and regular review is warranted.”



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