Stroke Risk
CHA2DS2-VASc
Renal Function
SCr µmol/L mg/dL
CrCl mL/min
This app applies only to patients who HAVE atrial fibrillation and DO NOT HAVE moderate to severe mitral stenosis and/or a mechanical heart valve. See full Guideline Recommendations in the Resources section for those patients with a mechanical valve.

This app is not yet updated with the 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation. It continues to be based on the 2019 Focused Update of the 2014 Guideline for the Management of Patients With Atrial Fibrillation. 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 evaluating for anticoagulation therapy, and minimize bleed risk whenever possible.

Risk Factors for Major Bleed (HAS-BLED) 

Non Modifiable

Modifiable

Specific Medications that Increase Bleed Risk

1 Consider Therapy Guidance 

Summary Advice

2 Select Therapy Option

3 Evaluate Therapy

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

Risk/Benefit Information*

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

Based on Table 7 from the 2014 AHA/ACC/HRS Atrial Fibrillation Guideline comparing CHA2DS2-VASc stroke risk stratification. 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.
  • To help minimize risk of bleed, address modifiable risk factors.
  • Combined use of the following medications with anticoagulants increases bleed risk. Reevaluate need for medications listed below, and 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)
Reversal Strategies Download Reversal Strategies Fact Sheet (N/A)

Resources

View Select Full-Text Guideline Recommendations  

Other Mobile Tools

References

  1. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: January C, Wann L, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation.
    J Am Coll Cardiol. 2019 Jul, 74 (1) 104–132.

  2. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: January C, Wann L, Alpert J, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. J Am Coll Cardiol. 2014 Dec, 64 (21) e1–e76.

  3. 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.

  4. 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

  5. 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

Calculations

Terms of Services

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About the App

When was this App last updated?

December 2023

How can I provide feedback?

How is this App intended to be used?

Use the updated AnticoagEvaluator to make informed decisions on initiation of antithrombotic therapy for patients with atrial fibrillation, in the absence of moderate to severe mitral stenosis or a mechanical heart valve. App updates include expanded advice from the 2018 Focused Update to the 2014 Guideline for the Management of Patients with Atrial Fibrillation.

Use the App to:
  • Calculate a patient's stroke risk (CHA2DS2-VASc) and renal function (Cockcroft-Gault Equation), and review factors that may contribute to bleed risk (HAS-BLED criteria and concomitant meds).
  • Consider updated stroke prevention therapy guidance based on the 2018 ACC/AHA/HRS Focused Update of the 2014 Guideline for the Management of Patients with Atrial Fibrillation.
  • Improve accurate use of DOACs with adjusted dosage based on prescribing information, fine-tuned for renal and other patient characteristics.
  • Evaluate appropriate therapy for a patient by reviewing:
    • Synthesized individualized risk for antithrombotic therapy options based on clinical trials (e.g., ACTIVE-A, RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE-AF)
    • Relevant safety information and full prescribing information for all therapy options

This app is not yet updated with the 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation. It continues to be based on the 2019 Focused Update of the 2014 Guideline for the Management of Patients With Atrial Fibrillation. The information and recommendations in this app are intended to support clinical decision making. They are not intended to represent the only or best course of care, or to replace clinical judgment for diagnosis, cure, mitigation, treatment, or prevention of disease. Use of this app assumes clinicians will conduct a full evaluation of the patient, consult relevant medical specialists as needed, and utilize a team-based approach to optimize therapy. In addition, therapeutic options should be determined after discussion between the patient and their care provider.

How was this App developed?

The app was developed as part of the ongoing mission of the College to generate and deliver actionable knowledge at the point of care to improve quality, efficiency, and patient outcomes. This app was originally developed as part of the ACC’s Anticoagulation Initiative, a comprehensive quality effort to improve care for patients on anticoagulation therapy. Financial support for the development of 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
Call: (202) 375-6000, ext. 5603 or (800) 253-4636
Fax: (202) 375-7000
Email: resource@acc.org