Considerations when choosing an appropriate bleeding risk assessment tool for patients with atrial fibrillation

Oral anticoagulation is integral to the management of patients with atrial fibrillation (AF) to reduce the risk of thromboembolism. Stroke risk should be assessed using the CHA2DS2‐VASc score and men with a CHA2DS2‐VASc score of ≥1 and women with CHA2DS2‐VASc score ≥2 should be offered anticoagulation.¹ However, use of anticoagulation increases the risk of bleeding events and thus bleeding risk must be taken into account when initiating anticoagulation, especially because anticoagulation‐related major bleeding in AF patients has been associated with a substantial increase in the risk of death, ischemic stroke, and myocardial infarction.2,3 Intracranial hemorrhage, the most serious form of bleeding, was linked with a hazard ratio (HR) of 121.5 (95% confidence interval [CI], 91.3‐161.8) for death and a HR of 22.0 (95% CI, 9.9‐48.8) for stroke or myocardial infarction.²