Stroke Risk
CHA2DS2-VASc
Renal Function
SCr µmol/L mg/dL
CrCl mL/min
This app is for non-valvular atrial fibrillation patients only, and should not be used to guide therapy in patients with mechanical or bioprosthetic valves. x

Calculate Risk

Patient Information

Required to derive therapy options

Age
Yrs
Sex

CHA2DS2-VASc

Select all that apply

Creatinine Clearance
(Cockcroft-Gault Equation)
Creatinine Clearance (Cockcroft-Gault Equation)

All four values are required to calculate Creatinine Clearance

Select Units
Age
Yrs
Sex
Weight
kgs lbs
Serum Creatinine
µmol/L mg/dL

Bleed Risk Considerations

Consider a patient's bleed risk when evalutating for anticoagulation therapy, and minimize bleed risk whenever possible.

Select all that apply

HAS-BLED 

Concomitant Medications

Review Therapy

1 Consider Therapy
Guidance
Consider Therapy Guidance

Oral anticoagulation may be omitted due to low stroke risk
The following therapy options may be considered due to intermediate stroke risk:
- No antithrombotic therapy
- Aspirin
- Oral anticoagulant
Oral anticoagulation therapy recommended due to high stroke risk

2 Select Therapy Option

3 Evaluate Therapy

Renal-Function Adjusted Dose Calculate Creatinine Clearance  
Standard Dose
(clinical trials)
Standard Dose (clinical trials)
 

Risk/Benefit Information*

Patient's ANNUAL risk of stroke + thromboembolism with % %
Relative risk reduction %
Absolute risk reduction %
Chance of benefit per year 1 in

Based on SPARC Tool developed by Peter Loewen, ACPR, Pharm.D., FCSHP

*This table refers to and calculates individualized annual risk of ischemic stroke and thromboembolism using relative risk reduction from the clinical trials in combination with individual risk factors. This data is not the result of head-to-head trials and cannot be compared side by side. An important difference is that the DOAC trials combined stroke and systemic embolism for relative risk reduction on therapy, compared to the placebo/no therapy that calculated stroke alone and to warfarin trials that calculated stroke alone.

Caution

  • When making treatment decisions, balance stroke prevention benefits with minimizing the risk of serious bleeding wherever possible.
  • Combined use of the following medications with anticoagulants increases bleed risk. Monitor your patient regularly:
    • -

Risk/Benefit Information*

Population avg ANNUAL risk of major bleed %
Population avg annual chance of being harmed by   (major bleed) 1 in
Patient's ANNUAL risk of major bleed (HAS-BLED) %
Patient's annual chance of being harmed by   (major bleed) 1 in

Based on SPARC Tool developed by Peter Loewen, ACPR, Pharm.D., FCSHP

*This table refers to and calculates individualized annual risk of major bleed using relative risk reduction from the clinical trials in combination with individual risk factors. This data is not the result of head-to-head trials.

Additional Dose Considerations
Major Side Effects
Drug Interactions For full list of interactions and all other safety information for this drug, see
prescribing information
(N/A)

Resources

Full Guidelines and other References

  1. 2014 ACC/AHA/HRS Atrial Fibrillation Guideline: January C.T., Wann L.S., Alpert J.S., et al; 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Developed in Collaboration With the Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;64:e1-76.

  2. CHA2DS2-VASc: Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010 Feb;137(2):263-72. doi: 10.1378/chest.09-1584. Epub 2009 Sep 17. PubMed PMID: 19762550.

  3. HAS-BLED: Pisters R, Lane DA, Nieuwlaat R, et al. A Novel User-Friendly Score (HAS-BLED) To Assess 1-Year Risk Of Major Bleeding In Patients With Atrial Fibrillation: The Euro Heart Survey. Chest. 2010;138(5):1093-1100

  4. Cockcroft-Gault Equation for CrCl: Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41. PubMed PMID: 1244564

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Calculations

Terms of Services

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About the App

When was this App last updated?

12th May 2017

How can I provide feedback?

How is this App intended to be used?

The ACC AnticoagEvaluator App helps clinicians assess antithrombotic therapy for their non-valvular atrial fibrillation patients. Use the App to:

  • Calculate a patient's stroke risk (CHA2DS2-VASc), bleed risk (HAS-BLED and concomitant meds), and renal function (Cockroft-Gault Equation)
  • Review stroke prevention therapy guidance based on AHA/ACC/HRS's 2014 Guidelines for the Management of Patients with Atrial Fibrillation
  • Consider characteristics of each therapy choice, including
    • standard and renal-adjusted dosing for oral anticoagulant therapy
    • safety and prescribing information for all therapy options
    • individualized risk for antithrombotic therapy options based on clinical trials(e.g., ACTIVE-A, RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE-AF)

The information and recommendations in this App are meant to support clinical decision making. They are not meant to represent the only or best course of care, or replace clinical judgment. Therapeutic options should be determined after discussion between the patient and their care provider.

How was this App developed?

This app was developed as part of the ACC's Anticoagulation Initiative. Financial support for the app was provided by Daiichi Sankyo, Inc. All content was independently developed with no sponsor involvement.

Its content was adapted from a web tool created by Peter Loewen, B.Sc.(Pharm), ACPR, Pharm.D., FCSHP, which can be viewed at http://www.sparctool.com/. The App was further refined and vetted through review and user testing by physicians, nurse practitioners, pharmacists, and other relevant specialists.

Sections of this App combine risk estimates from clinical prediction rules (e.g., CHA2DS2-VASc, HAS-BLED) with relative risk data from clinical trials (e.g., ACTIVE-A, RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE-AF) to produce individualized efficacy and bleeding risk estimates for patients. A detailed description of this methodology can be found at http://www.sparctool.com/sparcnotes.htm. Because relative risk effect sizes in this therapeutic area are quite stable across the spectrum of absolute risk, this method allows for reasonable comparison between clinical research studies that used different methodologies and study populations. Nonetheless, this type of approach is no substitute for sound clinical judgment.

Please see the Resources section of this App for links to additional references.

For Support
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