Um dos grandes problemas em relação ao uso dos anticoagulantes orais na fibrilação atrial é o risco de sangramentos. Em virtude disso, alguns escores de avaliação de risco de sangramento foram validados com o objetivo de identificar pacientes com maior potencial de complicações hemorrágicas. Dentre eles podemos citar o HEMORR2HAGES, HAS-BLED e o escore ATRIA. Um dos mais usados na prática clínica é o HAS-BLED. Você sabe o que consiste esse escore?
O HAS-BLED é um escore de avaliação de sangramento que foi validado em 2010. Através de uma avaliação clínico-laboratorial do paciente é estabelecido uma pontuação para cada item. Se a pontuação for maior ou igual a 03 esse paciente apresenta risco elevado de sangramento. Os critérios são os seguintes:
- Hipertensão arterial descontrolada (Hypertension)– Pressão arterial sistólica maior que 160mmhg
- Função renal ou hepática alterada (Abnormal renal and/or liver function)- Diálise, transplante ou creatinina >2,26 mg/dl; cirrose ou bilirrubinas maior que 02 vezes o normal e TGO/TGP maior que 3 vezes o normal
- História de AVC (Stroke history)
- Sangramento prévio importante ou predisposição a sangramentos (prior major Bleeding or predisposition to bleeding)
- Labilidade do INR (Labile INR)- usado para pacientes que usam warfarina e consiste no INR na faixa terapêutica em um tempo menor que 60%
- Idade ≥ 65 anos (Elderly)
- Drogas que interfiram na warfarina ou abuso de álcool (Drug or alcohol use) – uso de medicamentos como aspirina, clopidogrel, anti-inflamatórios não hormonais; uso de álcool maior ou igual a 08 “drinks” por semana
Importante lembrar que o escore HAS-BLED não deve ser usado isoladamente para contra-indicar a anticoagulação no paciente portador de fibrilação atrial. Sua principal função é identificar pacientes com potencial de evoluir com maiores complicações hemorrágicas e até mesmo realizar algumas interferências em fatores clínicos do paciente (suspender determinadas drogas, realizar melhor controle pressórico, evitar uso do álcool etc).
REFERÊNCIA:
- Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJGM, Lip GYN. A novel user-friendly score (HAS-BLED) to assess 1 year risk of major bleeding in patients with atrial fibrillation: the Euro heart survey. Chest 2010 Nov; 138 (5): 1093-100
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