
PERSONALIZED STROKE RISK ASSESSMENT IN ATRIAL FIBRILLATION (non valvular):
You have been diagnosed with a heart condition called atrial fibrillation. This means that the two small chambers in your heart are not beating properly, which could lead to pooling of the blood and clotting, which could then dislodge and go to the brain and cause a stroke. Because of this possibility, unless your risk score is very low, we recommend that you be on a blood thinner to reduce the risk. This handout is to help provide you with an estimation of your stroke risk and show you how this might change with different interventions. This is to help you come to an informed decision to help you choose one of the blood thinner options. It is important to understand that these numbers that you see are estimates as best as we know and are only there for guidance.

RISK FACTORS:
Age:	Congestive Heart Failure at any time:	Hypertension (Sys >160):
Systolic BP:	High blood pressure (controlled or not):	Abnormal Kidney function:
Female:	Age > 75:	Abnormal Liver function:
Diabetes type 1 or 2:	Diabetes type 1 or 2:	Stroke or TIA:
TIA or Stroke in past:	Stroke or TIA in past:	History of major Bleed:
	Vascular disease:	History of Labile INR:
	Age 65-75:	Elderly (>65):
	Sex: Female:	Taking antiplatelet Drug or NSAID:
		Current excess Alcohol use:

FRAMINGHAM	#	HAS BLED

NO THERAPY:
Your ANNUAL risk of stroke or serious blood clots IF NOT on treatment:							%
Your ANNUAL risk of major bleeding: %
Your FIVE YEAR risk of stroke or serious blood clots not on treatment: %

ASPIRIN 80-325 mg/day:
Your ANNUAL risk of stroke or serious blood clots on Aspirin:							%
Your ANNUAL risk of major bleeding: %
RRR: % ARR: % Chance of benefit per year: 1 in Cost per 3 months:

ASPIRIN 75-100 mg/day and CLOPIDOGREL 75 mg/day:
Your ANNUAL risk of stroke or serious blood clots on Aspirin and Plavix:							%
Your ANNUAL risk of major bleeding: %
RRR: % ARR: % Chance of benefit per year: 1 in Cost per 3 months:

WARFARIN INR 2-3:
Your ANNUAL risk of stroke or serious blood clots on Warfarin:							%
Your ANNUAL risk of major bleeding: %
RRR: % ARR: % Chance of benefit per year: 1 in Cost per 3 months:

DABIGATRAN 110 MG BID PO:
Your ANNUAL risk of stroke or serious blood clots on Dabigatran 110 mg:							%
Your ANNUAL risk of major bleeding: %
RRR: % ARR: % Chance of benefit per year: 1 in Cost per 3 months:

RIVAROXABAN 20 MG OD PO:
Your ANNUAL risk of stroke or serious blood clots on Rivaroxaban:							%
Your ANNUAL risk of major bleeding: %
RRR: % ARR: % Chance of benefit per year: 1 in Cost per 3 months:

APIXABAN 5 MG BID PO:
Your ANNUAL risk of stroke or serious blood clots on Apixaban:							%
Your ANNUAL risk of major bleeding: %
RRR: % ARR: % Chance of benefit per year: 1 in Cost per 3 months:

DABIGATRAN 150 MG BID PO:
Your ANNUAL risk of stroke or serious blood clots on Dabigatran 150 mg:							%
Your ANNUAL risk of major bleeding: %
RRR: % ARR: % Chance of benefit per year: 1 in Cost per 3 months:

General Notes:
Warfarin use requires blood work monitoring - initially every 1-2 days until stable, then every 2-4 weeks.
The newer agents (Dabigatran, Rivaroxaban, Apixaban, etc.) do not require blood work monitoring but are more expensive.
"Major bleeding" means risk for bleeding in and around the brain, bleeding requiring hospitalization, a haemoglobin drop > 20 g/L, or bleeding that needs transfusion. However it is important to know that the majority of patients with major bleeds have a good outcome and this needs to be weighed against the possible catastrophic effects of a stroke.
The risk estimates above are calculated using the "Framingham Stroke or Death after Atrial Fibrillation" tool, the tool and the "HAS BLED" tool. These tools take into account your age, sex and the presence or absence of certain medical conditions such as diabetes, high blood pressure, heart failure, previous stroke etc.

Subject:

eGFR
CREAT
AST
ALT
BILI
ALP

Medical History box:

The CHADS2 and CHA2DS2-VASc risk estimates are based on BMJ 2011;342:d124, 10 year follow-up estimates. This form is adapted with permission from the work by Peter Loewen UBC (Pharm.D, B.Sc. Pharm): www.peterloewen.com

Atrial Fibrillation Stroke Risk Advisor by Dr. D.A. Page is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License. Update V2_Feb4_2024, by Dr. John Yap. Permissions beyond the scope of this license may be available at http://creativecommons.org/ns.

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