Perspectives: Anticoagulation Management

Raffaele De Caterina

Raffaele De Caterina

MD, PhD, FESC

  • Professor and Director
  • Institute of Cardiology
  • University Chieti, Italy
  • Consultant
  • "G. Monasterio" Foundation for Medical Research
  • Pisa, Italy

 

Using risk assessment tools in clinical treatment for anticoagulation

As a first approach, the European Society of Cardiology has recommended staying with the CHADS2 score, and if a patient has a CHADS2 score of 2 or higher, this patient immediately is considered a potential candidate for anticoagulation.

The patients that fall in the category of a CHADS2 score of 0 and 1 can undergo a more refined risk assessment, which means the CHADS2VASc score. They have to be aware that there are higher risk factors, such as left ventricular dysfunction, or female gender.

These kinds of lesser well-known risk factors can still guide the doctor when prescribing an anticoagulant. So even if the patient has a CHADS2VASc score of 1, there is a preference for oral anticoagulation, and if the patient has a score of 0, the guidelines recommend no treatment for most of them because the patient is really at a very low risk of stroke.

The other risk assessment that I would always recommend is to assess the bleeding risk, because it is one thing to say that the patient is a candidate (being a candidate means that the patient fulfills the inclusion criteria). However, the bleeding risk still needs to be considered.

About the Coagulation Center

The Coagulation Center is an educational resource for healthcare professionals. Guided by a global editorial board of experts, the Coagulation Center offers a range of clinical perspectives on balancing the benefit and risk of anticoagulation in a rapidly changing landscape. Within the Coagulation Center you will find roundtable discussions on anticoagulation management, materials for patient management including patient case studies, tools to help evaluate bleeding risk and stroke risk, and downloadable resources for your practice.