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1、NewNewBleedingBleedingSceSceHASHASBLEDBLEDWillWillHelpHelpGuideGuideAnticoagulationAnticoagulationininAFAF(2011010623:45:06)January52011(BirminghamUnitedKingdom)—Anovelscefpredictingbleedingriskinpatientswithatrialfibril

2、lation(AF)calledHASBLEDperfmedbetterthananyothercontemparysceinalargecohtofanticoagulatedpatientsthescecouldbecomeanimptantnewclinicaltoolsayresearchers[1].ThisisthesecondvalidationofHASBLEDitwasderivedfromfirstvalidated

3、inaEuropeanAFpopulationlastyear[2].HASBLEDispragmaticitsaneasyassessmenthelpsdoctstomakeaninfmeddecisionratherthanguessing.“HASBLEDispragmaticitsaneasyassessmenthelpsdoctstomakeaninfmeddecisionratherthanguessing.Itsthere

4、totellyouifthebleedingsceishighenoughthatmecautionmeregularreviewofyourpatientisneeded“theleadauthofthenewpaperDrGregyYHLip(UniversityofBirminghamUK)toldheartwire.LippointsoutthatuseofHASBLEDisrecommendedinthenewEuropean

5、SocietyofCardiology(ESC)guidelinesonAFaswellinthelatestguidanceonAFfromtheCanadianCardiovularSociety.InaneditialaccompanyingLipetalspaper[3]DrStefanHHohnloser(JWGoetheUniversityFrankfurtGermany)saysthatHASBLEDisan“imptan

6、tstep““mayindeedprovetobeanimptantclinicaltooltoassessbleedingriskinAFpatients.“Howeverhecautionsthatitremainstobeseenhowitwillperfmindailyroutinepracticewhethersuchableedingscedevelopedfromdataonpatientsreceivingwarfari

7、nothervitaminKantagonistscanalsobeappliedduringuseoftheneweranticoagulantswhichmayhavelesserbleedingrisks.ASimpleToolThatWillBeInvaluabletoCardiologistsLipsaysthatoptimumionofpatientswithAFfanticoagulationtherapydependsn

8、otonlyonassessmentoftheirriskofstrokebutalsoonidentificationofthoseatincreasedriskofdevelopingbleedingcomplications.HohnloseragreesnotingthatcurrentlyanticoagulationtherapyinAFis“underusedsuboptimallyappliedofteninapprop

9、riatelydiscontinued...drivenfamentallynowwithvariousiPhoneappsdoctsmuststillusetheirinitiativetoacertaindegreewhenscing.Finstancealthough“elderly“isdefinedasover65thisisreallyanassessmentof“biologicalage“aguidetofrailtyh

10、esays.“Ihave90yearoldAFpatientswhoarebiologically7060yearoldswhoarebiologically99.“PhysiciansshouldalsorememberthatthebleedingriskcanbemodifiedHASBLED“makesyouthinkaboutthingsyoucancrect“henotes.Stoppingaspirintherapyisa

11、goodexampleofawaytoreducebleedingriskcontrollinghypertension.thereisnoreasonwhyHASBLEDcannotbemodifiedinthefutureifotherrisksfbleedingareidentifiedhenotes.“Thereisalwaysscopefrefiningvariousriskassessmentmodelsgivenhowme

12、dicineevolves.“HepointstohisownteamsmodificationoftheCHADS2scefassessingstrokeriskasanexampleofthis.TheyrefinedittobecomeCHA2DS2Vanewmesensitivemodelincludingadditionalpointsfspecificagecategiespresenceofvulardiseasefema

13、legender.HASBLEDBetterThanOtherBleedingScesInthenewstudyLipcolleaguescombinedtheSPTIFIIIVclinicaltrialsevaluatedthepredictivevalueofseveralbleedingriskstratificationschemasinthe7329participatingpatientswithAF.Lippointsou

14、tthatthisisthelargestvalidationofHASBLEDtodatethefirstinananticoagulatedpopulation:participantsreceivedeitherwarfarinfixeddoseximelagatran36mgtwicedaily(ximelagatranwassubsequentlywithdrawnfollowingconcernsaboutliversafe

15、ty).OfthetestedschemastheHASBLEDsceperfmedbestmeaccuratelydiscriminatingpatientsonthebasisofbleedingriskwithastepwiseincreaseinratesofmajbleedingwithincreasingHASBLEDsce(pftrend0.0001).Hohnlosersaysthatthisnewvalidationo

16、fHASBLEDconfirms“thepredictivepowerofthissce“whichmaybeassociatedwithbetterpredictiveaccuracythanitspredecesss.Onmultivariateanalysisthenewsceaddedsignificantlytothosemodelsthatalreadyincpatedoldmodelsbutincontrastnoneof

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