What should be done to reduce the risk of bleeding in patients with AF?
Patients with anemia or reduced platelet count or function should be treated where possible to improve their hemoglobin or platelet count. Causes of renal impairment should be investigated and where possible reversed. Patients with liver function abnormalities were generally excluded from the randomized trials, and especially where there is abnormal clotting tests, such patients may be at higher risk of bleeding on VKA, possibly less so on NOACs; in cirrhotic patients, ischemic stroke reduction may outweigh bleeding risk. Additionally, since 2006, six risk scores have been developed and validated for the assessment of bleeding risk in AF populations. The number of risk factors included in the bleeding risk schemas varies considerably, from three and the score or weighting associated with each risk factor also differs. Age and prior bleeding are included as risk factors in all 6 bleeding risk scores but different age cutoffs are utilized, with 3 scores employing age 75 years or greater to indicate greater bleeding risk.