AFib Anticoagulation Decision
CHA₂DS₂-VASc Stroke Risk → HAS-BLED Bleeding Risk
Anticoagulation in atrial fibrillation (AF) reduces stroke risk by approximately 64% compared to placebo, but carries bleeding risk that must be weighed against benefit. This pathway integrates CHA₂DS₂-VASc for stroke risk stratification with HAS-BLED for bleeding risk assessment, reflecting the 2023 ACC/AHA/ACCP/HRS AF guideline recommendations. A CHA₂DS₂-VASc score ≥ 2 (men) or ≥ 3 (women) represents clear benefit from anticoagulation. HAS-BLED is used to identify and modify correctable bleeding risk factors, not to withhold anticoagulation from high-stroke-risk patients.
Pathway Steps
Atrial Fibrillation Confirmed
Confirm AF diagnosis before anticoagulation scoring
CHA₂DS₂-VASc Score
Check each risk factor present — age ≥ 75 and prior stroke/TIA each count as 2 points
HAS-BLED Bleeding Risk Score
Identify bleeding risk and modifiable factors — high score should prompt risk modification, not anticoagulation withholding
Clinical Disclaimer
Anticoagulation decisions require individualized assessment, patient preferences, and shared decision-making. This pathway does not apply to patients with valvular AF (mitral stenosis, mechanical heart valves) who require warfarin regardless of CHA₂DS₂-VASc score. A high HAS-BLED score should prompt modification of reversible bleeding risk factors, not automatic withholding of anticoagulation from high-stroke-risk patients.