Perspectives: Risk Assessment

David Allen Garcia

David Allen Garcia


  • Professor
  • Division of Hematology
  • University of Washington
  • Seattle, WA USA

Patient awareness and treatment options

I do quote the statistics. For example, a patient with idiopathic venous thrombosis who’s had 6 months of therapy and chooses to stop warfarin has a 30% risk, roughly, of recurrent thrombotic disease over the next 10 years. If they choose to continue warfarin, they have a 1 to 2% annual risk of major bleeding. By major bleeding, I mean intracranial and gastrointestinal bleeding—hemorrhage that’s serious.

Those numbers are easy to quote and I do quote them to patients, but of course, the real story is more complex than that, because a patient might be much more worried about having an intracranial hemorrhage than they would be about having a recurrent popliteal deep vein thrombosis. Therefore, it is important to take the time to make sure patients are educated about their risks for thromboembolism, and the benefits and risks of anticoagulation. This is important to allow patients to participate in making informed treatment decisions. Yet, we don’t always have time to go into those sorts of level of detail in the typical office visit. So, it is important to rely on other healthcare professionals, like nurses, nurse practitioners, and clinical pharmacists, to provide this education. Some patients may benefit from being followed in anticoagulation clinics.

What I try to do is present the statistics about the potential risks involved in a manner they can understand, summarize the treatment options available, then have the patient present his or her personal preferences. Based on that information, I make a treatment decision that makes sense for that individual.

Risk assessment

Risk assessment

Here you can find validated, interactive tools to help you calculate stroke and bleeding risk of your patients

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.