Riesgo embólico, riesgo isquémico y riesgo hemorrágico

Atrial fibrillation is the most prevalent cardiac arrhythmia in the general population. Its presence increases the risk of thromboembolic events 5-fold. Although antithrombotic treatment reduces this risk, in contrast it increases the potential risk of bleeding, with intracranial hemorrhage being the most feared complication. However, not all patients have the same risk. Consequently, a number of different thromboembolic riskscores have been developed in recent years (e.g. the CHADS₂, CHA₂DS₂-VASc and ATRIA stroke risk scores). The CHA₂DS₂-VASc score is the one recommended by clinical practice guidelines for optimizing antithrombotic therapy in patients with atrial fibrillation. These same clinical guidelines recommend that both bleeding and thromboembolic risk should be assessed and various risk scores have been proposed for assessing hemorrhagic risk (e.g. the HEMORR₂HAGES, HAS-BLED, ATRIA bleeding risk and ORBIT-AF scores). Currently, however, none has been explicitly recommended in European guidelines. It is vital that the net clinical benefit of antithrombotic therapy is assessed to ensure that the expected advantages of anticoagulation treatment outweigh the harm that could be caused by potential hemorrhages.

Supplement information: this article is part of a supplement entitled “Treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention: an update”, which is sponsored by Boehringer Ingelheim.