title: Joint use of cardio-embolic and bleeding risk scores in elderly patients with atrial fibrillation.
abstract: BACKGROUND
  Scores for cardio-embolic and bleeding risk in patients with atrial fibrillation are described in the literature. However, it is not clear how they co-classify elderly patients with multimorbidity, nor whether and how they affect the physician's decision on thromboprophylaxis.
  
  
  METHODS
  Four scores for cardio-embolic and bleeding risks were retrospectively calculated for ≥ 65 year old patients with atrial fibrillation enrolled in the REPOSI registry. The co-classification of patients according to risk categories based on different score combinations was described and the relationship between risk categories tested. The association between the antithrombotic therapy received and the scores was investigated by logistic regressions and CART analyses.
  
  
  RESULTS
  At admission, among 543 patients the median scores (range) were: CHADS2 2 (0-6), CHA2DS2-VASc 4 (1-9), HEMORR2HAGES 3 (0-7), HAS-BLED 2 (1-6). Most of the patients were at high cardio-embolic/high-intermediate bleeding risk (70.5% combining CHADS2 and HEMORR2HAGES, 98.3% combining CHA2DS2-VASc and HAS-BLED). 50-60% of patients were classified in a cardio-embolic risk category higher than the bleeding risk category. In univariate and multivariable analyses, a higher bleeding score was negatively associated with warfarin prescription, and positively associated with aspirin prescription. The cardio-embolic scores were associated with the therapeutic choice only after adjusting for bleeding score or age.
  
  
  CONCLUSIONS
  REPOSI patients represented a population at high cardio-embolic and bleeding risks, but most of them were classified by the scores as having a higher cardio-embolic than bleeding risk. Yet, prescription and type of antithrombotic therapy appeared to be primarily dictated by the bleeding risk.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada. Electronic address: Marcucci.maura@gmail.com.
authors.forename: Maura
authors.initials: M
authors.lastname: Marcucci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Nobili
authors.forename: Mauro
authors.initials: M
authors.lastname: Tettamanti
authors.forename: Alfonso
authors.initials: A
authors.lastname: Iorio
authors.forename: Luca
authors.initials: L
authors.lastname: Pasina
authors.forename: Codjo D
authors.initials: CD
authors.lastname: Djade
authors.forename: Carlotta
authors.initials: C
authors.lastname: Franchi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marengoni
authors.forename: Francesco
authors.initials: F
authors.lastname: Salerno
authors.forename: Salvatore
authors.initials: S
authors.lastname: Corrao
authors.forename: Francesco
authors.initials: F
authors.lastname: Violi
authors.forename: Pier Mannuccio
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D004617:Embolism / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin
keywords: Atrial fibrillation; Bleeding risk; Cardioembolic risk; Elderly; Prediction guides; Thromboprophylaxis