Perspectives: Lessons Learned From VKAs

Raffaele De Caterina

Raffaele De Caterina


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


The use of bleed risk assessment tools

Well, there have been several risk formulas for bleeding, and what was adopted in the ESC guidelines is the so-called HAS-BLED score. These scores compile several elements that are partially different from the risk factors for stroke, and can tell you, more or less, which patients are more prone to bleeding. Some factors are relatively obvious (such as age, liver disease, or kidney disease).

Some of these elements are factors that coexist with risk factors for stroke. For example, hypertension is a risk factor both for bleeding and for stroke. However, what we advised in the ESC guidelines is that, while you use the risk score to help identify whether the patient is more or less prone to bleeding, this does not represent a traffic light that gives a red light, or a green light, but rather is indicative of a warning for patients that have a high-risk of bleeding. In this case, the guidelines tell you that you should be somewhat alerted that you may come across a problem.

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.