Deans' stroke musings: (a) In patients with atrial fibrillation, 2 tools are best for predicting risk for stroke; a third tool is best for predicting risk for bleeding

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, December 28, 2015

(a) In patients with atrial fibrillation, 2 tools are best for predicting risk for stroke; a third tool is best for predicting risk for bleeding

I'll soon find out if this applies to me.
http://www.mcmasteroptimalaging.org/full-article/07bd6b405cc395b2de8727fbab083fb7

Lopes RD, Crowley MJ, Shah BR, et al. Stroke Prevention in Atrial Fibrillation AHRQ Comparative Effectiveness Review. Rockville, MD: Agency for Healthcare Research and Quality; 2013 Aug. Report No 13-EHC113-EF.

Review question

How effective are tools for predicting stroke and bleeding risk in patients with atrial fibrillation?

Background

Atrial fibrillation is an abnormal heart rhythm that can cause small clots to form in the heart. These clots can travel to the brain, causing a stroke.

Anticoagulant (or blood thinning) treatment is the therapy of choice for preventing stroke in non-valvular atrial fibrillation. However, anticoagulants can cause bleeding. People with atrial fibrillation vary a lot in their risk of stroke from AF, and in their risk of bleeding.

Prediction tools assess which people are most likely to benefit from treatment and which are most likely to be harmed.

How the review was done

This summary is based on a systematic review of 37 studies on predicting stroke risk and 17 studies on predicting bleeding in people with atrial fibrillation. Average age of participants ranged from 53 to 81 years. Publication period was 2000 to 2012.

What the researchers found

Scores from the CHADS2 and CHA2DS2-VASc are best for predicting risk for stroke. Their average prediction value is 0.70 (ranging from 0.66 to 0.75).

A value of 0.50 means that the tool is no better than chance in predicting an outcome. A value of 1.0 means that the tool predicts an event with certainty.

The strength of the evidence for these 2 tools is low.

The HAS-BLED score is best for predicting bleeding risk. Strength of the evidence is moderate.

Conclusions

The CHADS2 and CHA2DS2-VASc scores are best for predicting stroke in people with atrial fibrillation.

HAS-BLED scores are best for predicting bleeding risk.

Tools for predicting stroke or bleeding

Tool	Description
CHADS2	Congestive heart failure; Hypertension; Age 75 or older; Diabetes; prior Stroke [2 points]
CHA2DS2-VASC	Congestive heart failure; Hypertension; Age 75 or older [2 points]; Diabetes; prior Stroke [2 points]; Vascular disease; Age 65 to 74; Sex = female
HAS-BLED	1 point for each of Hypertension; Abnormal kidney or liver function; Stroke; Bleeding history or predisposition; Labile international normalized ratio; Elderly [older than 65]; Drugs/alcohol concomitantly