[vhfpmr (OP)]

AF risks blood clots, clots cause strokes, anticoagulants reduce the risk of clots but increase the risk of haemorrhage.

CHA2DS2-VASc estimates the risk of additional ischaemic strokes incurred by AF patients, and HASBLED estimates the increased risk of haemorrhagic strokes to patients taking anticoagulants. So, from the data in the NICE guidelines, it's possible to tabulate the net risk of stroke for each combination of Chads & Hasbled (below).


Nice Anticoag.JPG (53.64 kB . 682x407 - viewed 3356 times)

Both NICE and ESC guidelines seem inline with this:

NICE clinical guideline 180: Atrial fibrillation: the management of atrial fibrillation
"1.5.2 Consider anticoagulation for men with a CHA2DS2-VASc score of 1. Take the
bleeding risk into account.

1.5.3 Offer anticoagulation to people with a CHA2DS2-VASc score of 2 or above,
taking bleeding risk into account."

2016 ESC Guidelines for the management of atrial Fibrillation
"9.1.1 In general, patients without clinical stroke risk factors do not need
antithrombotic therapy"

However, the ESC guidelines then go on to say:
"9.1.3 A high bleeding risk score should generally not result in withholding OAC. Rather, bleeding risk factors should be identified and treatable factors corrected"

This seems contrary to me. If HASBLED has been calculated from patients whose treatable risks haven't been treated, what's the point of it, or alternatively, if it's been calculated from patients whose risks are being managed, what's the point of the advice in 9.1.3?