Warfarin decreases stroke risk in atrial fibrillation patients, with efficacy and
safety impacted by the quality of warfarin control, as measured by time in therapeutic
range (TTR). Stroke and bleed risk scores are calculated prior to commencing warfarin,
so it would be beneficial if these scores also identified likely warfarin control.
Some studies have investigated CHADS2, CHA2DS2VASc, and HASBLED individually for this purpose, but application of all scores to
diverse ethnic populations and at sites with differing overall control has not been
investigated. The aim of this study was to determine if these commonly used risk scores
could identify poor warfarin control.
Retrospective data was collected for non-valvular AF patients receiving warfarin between
January and June 2014 in Australia and Singapore. Patient data was used to calculate
TTR and risk scores. Mean TTR was used for analysis and comparison to categorised
scores.
There were 3199 patients in Australia and 1171 in Singapore. At both sites, mean TTR
decreased according to HASBLED category, and there was a statistically higher percentage
of patients achieving a TTR > 65% in the low HASBLED category. The association between HASBLED scores and TTR was
independent of lower dosing in higher risk patients, particularly in Australia. No
significant differences were found in mean TTR according to CHADS2 at either site. Time in therapeutic range significantly decreased according to high
CHA2DS2VASc category in Singapore, but no differences were found in Australia.
Of the bleed and stroke risk models, HASBLED is most suitable to identify a patient’s
potential TTR and ability to achieve TTR > 65%. A high HASBLED score may assist prescribers in determining potential suitability
to warfarin, and assist prescribers in deciding on the most suitable anticoagulant
for patients.
Keywords
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Article info
Publication history
Published online: November 28, 2017
Accepted:
November 19,
2017
Received in revised form:
October 25,
2017
Received:
August 2,
2017
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
