Assessing bleeding risk in 4824 Asian patients with atrial fibrillation: The Beijing PLA Hospital Atrial Fibrillation Project

Abstract

The risks of major bleeding and intracranial hemorrhage (ICH) are higher in Asian patients with atrial fibrillation (AF) compared to non-Asians. We aimed to investigate risk factors for bleeding, and validate the predictive value of available bleeding risk scores (mOBRI, HEMORR2HAGES, Shireman, HAS-BLED, ATRIA and ORBIT) in a large cohort of Chinese inpatients with AF. Using hospital electronic medical databases, we identified 4824 AF patients (mean age 67 years; 34.9% female) from January 1, 1995 to May 30, 2015, with median (interquartile) in-hospital days of 10 (7–16) days. On multivariate analysis, prior bleeds, vascular disease, anemia, prior stroke, and liver dysfunction were independent risk factors of major bleeding (all p < 0.05). C-statistics (95%CI) of the HAS-BLED score were 0.72 (0.65–0.79) for major bleeding events and 0.83 (0.75–0.91) for ICH (all p < 0.001). Compared to other risk scores, the HAS-BLED score was significantly better in predicting major bleeding events (Delong test, all P < 0.05, apart from mOBRI, HEMORR2HAGES) and ICH (all p < 0.05), and additionally, resulted in a net reclassification improvement (NRI) of 17.1–65.5% in predicting major bleeding events and 29.5–67.3% in predicting ICH (all p < 0.05). We conclude that the HAS-BLED score had the best predictive and discriminatory ability for major bleeding and ICH in an Asian/Chinese AF population.

Incidence, risk factors, and outcomes of warfarin‐associated major bleeding in Thai population

“…With ROC of 0.91, the HAS‐BLED score showed a very strong correlation with bleeding events and could potentially be useful to predict bleeding in Thai NVAF patients. This finding is consistent with previous studies conducted in Asian populations which suggested that HAS‐BLED can effectively be used in Asian population . Guo et al evaluated the predictive value of various bleeding risk scores including HAS‐BLED scores in 4824 Chinese patients with AF .…”

“…One of the most commonly used score is the HAS‐BLED score developed for patients with NVAF . A recent cohort study from China suggested that the HAS‐BLED score outperformed other bleeding risk scores and may have a potential use in Asian population . For Thai population, the predictive and discriminatory ability of HAS‐BLED have never been tested.…”

“…19 A recent cohort study from China suggested that the HAS-BLED score outperformed other bleeding risk scores and may have a potential use in Asian population. 20 For Thai population, the predictive and discriminatory ability of HAS-BLED have never been tested. Based on all these issues, we therefore aimed to evaluate the incidence, risk factors, and outcomes of WAMB in Thai patients.…”

Accuracy of HAS‐BLED and other bleeding risk assessment tools in predicting major bleeding events in atrial fibrillation: A network meta‐analysis

“…Among high-sensitivity assessment tools, mOBRI was proposed earlier and included risk factors such as age ≥65 years, stroke, gastrointestinal bleed, and comorbidities (recent myocardial infarction, hematocrit <30%, creatinine >1.5 mg/dL, or diabetes mellitus). 41 The…”

Evaluation of the predictive performance of bleeding risk scores in patients with non‐valvular atrial fibrillation on oral anticoagulants

“…1,3,[11][12][13][14] Only few evaluation studies involved patients with non-valvular atrial fibrillation (NVAF) receiving NOACs, 6,12 and a limited number of validation studies were conducted in Asian patients. [15][16][17][18][19] Ideally, the validity and applicability of a BRS need to be examined prior to its routine use in a population other than the original derivation cohort. Therefore, we aimed to assess the calibration and discrimination of the first 6 established BRSs among Malaysian patients with NVAF receiving warfarin (dose adjusted to achieve an INR target value of 2-3) or NOAC therapy.…”