SPARCtool

SpreadsheetConverter

SPARCtool - Stroke Prevention in Atrial Fibrillation Risk Tool

for estimating risk of stroke and benefits & risks of antithrombotic therapy in patients with chronic nonvalvular atrial fibrillation

Developed by Peter Loewen, ACPR, Pharm.D., FCSHP

peter.loewen@ubc.ca

references/notes

MAJOR UPDATE

DISCLAIMER: this tool may be used unaltered for learning purposes and the author assumes no responsibility whatsoever for any decisions or harms to anyone resulting from its use. The author makes no representations, conditions or warranties, either express or implied, regarding this tool.

Patient:

Date:

In your patient with atrial fibrillation, which of the following stroke or bleeding risk factors are present?

Stroke Risk (CHA2DS2-VASc)

Age

<65

65-74

75+

TIA or stroke
(at any time in the past)

CHF/LV dysfunction
(diagnosed at any time in the past)

Prior MI, peripheral artery disease, or aortic plaque

Hypertension
(controlled or uncontrolled)

Female

Diabetes Type I or II
(controlled or uncontrolled)

CHA2DS2-VASc SCORE (0-9):

Major Bleeding Risk (HAS-BLED)

Abnormal renal function
(dialysis, SCr>200 mcmol/L, or transplant)

History of labile INR
(time in therapeutic range <60%)

Hypertension
(SBP>160mmHg)

Current use of alcohol
(>8 drinks per week)

Abnormal liver function
(cirrhosis or liver enzymes >3x ULN)

Currently taking antiplatelet drug or NSAID

History of major bleeding
(any cause)

HAS-BLED SCORE (0-9):

Which therapy options to HIDE?

ASA

dabigatran

ASA+clopidogrel

rivaroxaban

Hide stroke/bleed chart

warfarin

apixaban

Hide net clin benefit chart

edoxaban

PERCENT PER YEAR

therapy option

net clinical benefit (strokes prevented per major bleed caused)

annual risk of stroke/embolism

annual risk of major bleeding (intracranial bleeding, bleeding requiring hospitalization, HgB decrease of > 20 g/L, or need for transfusion)

no therapy

n/a

ASA

ASA+clopidogrel

warfarin

dabigatran 110

dabigatran 150

rivaroxaban

apixaban

edoxaban 30

edoxaban 60

DETAILED RISK ESTIMATES

Text for EMR:

""

no therapy

Patient's annual risk of stroke+thromboembolism with no therapy:

Patient's annual risk of stroke or TIA with no therapy if they did NOT HAVE AF (for comparison):

Patient's annual risk of major bleed:

ASA 80-325mg/d

not recommended by most international AF guidelines due to inferior efficacy vs. OACs with similar risk of major bleeding

Patient's annual risk of ischemic stroke+thromboembolism with ASA:

Relative risk reduction:

Absolute risk reduction:

Chance of benefit per year on therapy (vs. no therapy):

Patient's annual risk of major bleed:

Chance of major bleeding per year on therapy (vs. no therapy):

Strokes prevented per major bleed caused (Net Clinical Benefit):

ASA 75-100mg/d + clopidogrel 75mg/d

not recommended by most international AF guidelines due to inferior efficacy vs. OACs with similar risk of major bleeding

Patient's annual risk of ischemic stroke+thromboembolism with ASA+clopidogrel:

Relative risk reduction:

Absolute risk reduction:

Chance of benefit per year on therapy (vs. no therapy):

Patient's annual risk of major bleed:

Chance of major bleeding per year on therapy (vs. no therapy):

Strokes prevented per major bleed caused (Net Clinical Benefit):

warfarin INR 2-3

Patient's annual risk of ischemic stroke+thromboembolism with warfarin INR 2-3:

Relative risk reduction:

"0"

Absolute risk reduction:

Chance of benefit per year on therapy (vs. no therapy):

Patient's annual risk of major bleed:

Chance of major bleeding per year on therapy (vs. no therapy):

Strokes prevented per major bleed caused (Net Clinical Benefit):

dabigatran 110mg twice daily

Patient's annual risk of ischemic stroke+thromboembolism with dabigatran 110mg twice daily:

Relative risk reduction:

Absolute risk reduction:

Chance of benefit per year on therapy (vs. no therapy):

Patient's annual risk of major bleed:

Chance of major bleeding per year on therapy (vs. no therapy):

Strokes prevented per major bleed caused (Net Clinical Benefit):

dabigatran 150mg twice daily

Patient's annual risk of ischemic stroke+thromboembolism with dabigatran 150mg twice daily:

Relative risk reduction:

Absolute risk reduction:

Chance of benefit per year on therapy (vs. no therapy):

Patient's annual risk of major bleed:

Chance of major bleeding per year on therapy (vs. no therapy):

Strokes prevented per major bleed caused (Net Clinical Benefit):

rivaroxaban 20mg once daily

Patient's annual risk of ischemic stroke+thromboembolism with rivaroxaban:

Relative risk reduction:

Absolute risk reduction:

Chance of benefit per year on therapy (vs. no therapy):

Patient's annual risk of major bleed:

Chance of major bleeding per year on therapy (vs. no therapy):

Strokes prevented per major bleed caused (Net Clinical Benefit):

apixaban 5mg twice daily

Patient's annual risk of ischemic stroke+thromboembolism with apixaban:

"0"

Relative risk reduction:

Absolute risk reduction:

Chance of benefit per year on therapy (vs. no therapy):

Patient's annual risk of major bleed:

Chance of major bleeding per year on therapy (vs. no therapy):

Strokes prevented per major bleed caused (Net Clinical Benefit):

edoxaban 30mg once daily

Patient's annual risk of ischemic stroke+thromboembolism with edoxaban 30mg:

"0"

Relative risk reduction:

Absolute risk reduction:

Chance of benefit per year on therapy (vs. no therapy):

Patient's annual risk of major bleed:

Chance of major bleeding per year on therapy (vs. no therapy):

""

Strokes prevented per major bleed caused (Net Clinical Benefit):

edoxaban 60mg once daily

Patient's annual risk of ischemic stroke+thromboembolism with edoxaban 60mg:

"0"

Relative risk reduction:

71%

Absolute risk reduction:

Chance of benefit per year on therapy (vs. no therapy):

Patient's annual risk of major bleed:

Chance of major bleeding per year on therapy (vs. no therapy):

Strokes prevented per major bleed caused (Net Clinical Benefit):