Comparison of HAS-BLED with other risk models for predicting the bleeding risk in anticoagulated patients with atrial fibrillation

Zeng, Junquan; Yu, Peng; Cui, Wenjuan; Wang, Xiaoping; Ma, Jianyong; Zeng, Changai

doi:10.1097/md.0000000000020782

Cited by 10 publications

(11 citation statements)

References 39 publications

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“…However, choosing an appropriate individualized antithrombotic regimen is still a difficult clinical treatment [2][3][4][5]. At present, various scores are used to assess the bleeding risk after anticoagulation in patients with atrial fibrillation, but whether it is suitable for patients with atrial fibrillation and coronary heart disease is still inconclusive [6]. e SAMe-TT2R2 score was proposed by Apostolakis [7] in 2013, which is used to predict the anticoagulation efficacy of warfarin in patients with atrial fibrillation and provide a reference for the selection of anticoagulant drugs.…”

Section: Introductionmentioning

confidence: 99%

[Retracted] Evaluation of ABC Bleeding Score and SAMe‐TT2R2 Score on the Risk of Bleeding after Anticoagulation in Patients with Nonvalvular Atrial Fibrillation Complicated with Coronary Heart Disease

Zhang

et al. 2022

Contrast Media & Molecular Imaging

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Objective. To explore the predictive value of ABC bleeding score and SAMe-TT2R2 score on the risk of bleeding in patients with nonvalvular atrial fibrillation (NVAF) complicated with coronary heart disease (CHD) after anticoagulation. Methods. 149 patients with NVAF complicated with CHD were followed up in our hospital for one year. The bleeding events during the follow-up period were observed, the ABC bleeding score and SAMe-TT2R2 score were calculated, the predictive value of the two scoring methods for the main bleeding risk was analyzed by the ROC curve, and the AUC area under the ROC curve of the two scoring methods was compared by the Delong test. Results. There were 32 bleeding events during the follow-up period. The AUC of ABC bleeding score and SAMe-TT2R2 score were 0.775 ( P < 0.01 ) and 0.624 ( P < 0.05 ), respectively. The Delong test showed that the AUC of ABC bleeding score was significantly higher than that of SAMe-TT2R2 score (d = 2.177, P < 0.05 ). Conclusion. Both the ABC bleeding score and SAMe-TT2R2 score can predict the risk of bleeding after anticoagulation in patients with NVAF and CHD. The critical value of the SAMe-TT2R2 score for predicting bleeding events in patients with NVAF and CHD may need to be increased to 4 or 5, and the prediction ability of ABC bleeding score is significantly better than that of the SAMe-TT2R2 score.

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Section: Introductionmentioning

confidence: 99%

[Retracted] Evaluation of ABC Bleeding Score and SAMe‐TT2R2 Score on the Risk of Bleeding after Anticoagulation in Patients with Nonvalvular Atrial Fibrillation Complicated with Coronary Heart Disease

Zhang

et al. 2022

Contrast Media & Molecular Imaging

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“…In our study this system has also proved to be the only independent contributor to severe bleeding. Nevertheless, it is important to remark that compared to other scoring systems (HEMORR2HAGES, ATRIA, or ORBIT), the HAS-BLED score distributed more major bleeding events into the "low" or "moderate" risk categories (28).…”

Section: U N C O R R E C T E Dmentioning

confidence: 86%

Risk of bleeding after ground-level falls in elderly patients with atrial fibrillation and warfarin therapy

Bezak¹,

Vachalcova²,

Kissova³

et al. 2023

BLL

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OBJECTIVES: The aim of this study was to investigate bleeding risk in patients treated with VKAs after ground-level falls, considering the type and severity of bleeding. METHODS: The study was designed as a retrospective cohort study and included a total of 204 elderly patients aged > 65 years treated for AF continuously with warfarin for more than 3 years. Data were obtained from hospital registries in Bratislava, Slovakia. A 5-year assessment of death/survival was performed to determine mortality. RESULTS: There was no statistically signifi cant difference in severe bleeding (2.13 % with falls vs 2.55 % without, p = 1) and 5-year mortality (45 % and 38 % respectively, p = 0.3987) based on the presence of falls. Multivariate analysis, after adjustment for age, CHA 2 DS 2 VASc, HASBLED, stroke history, labile INR and number of falls showed that only HASBLED score was a statistically signifi cant contributor (CI: 1.0245 -1.0919, p = 0.0007) to severe bleeding. There was statistically signifi cant difference in severe bleeding (18 % vs 0 %, p = 0.0132) between patients suffering from spontaneous and bleeding after falls and also when comparing individual bleeding episodes (12 % vs 1 %, p < 0.0001). There was no statistically signifi cant difference in 5-year mortality between the two groups (43 % vs 42 % respectively, p = 0.3931). CONCLUSIONS: Our results show that occurrence of falls in AF patients treated with VKAs have no signifi cant impact on the incidence of severe bleeding and 5-year mortality and that spontaneous bleeding was associated with a signifi cantly higher risk of severe bleeding compared to bleeding after falling (Tab. 4, Ref. 30).

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“…12 13 Many bleeding risk scores have been published thus far 33 , and the HAS-BLED score 14 has been found to be superior or performing equally compared to more complex risk 15 scores or clinical approaches exclusively focused on modifiable bleeding risk 16 factors [34][35][36][37] . Several systematic review and meta-analyses examining the differential 17 ability of the various bleeding risk scores have been published, and all indicate that 18 the HAS-BLED score provided better predictive ability, and expressing the best 19 balance between sensitivity and specificity 5,[38][39][40] . The ORBIT score was originally 20 derived from a largely anticoagulated cohort from the 'Outcomes Registry for Better 21 Informed Treatment of Atrial Fibrillation' (ORBIT-AF) study, with the aim to provide a 22 simpler score with better predictive ability, with good calibration 18,41 .…”

Section: Statistical Analysis 15mentioning

confidence: 99%

Comparison of HAS-BLED and ORBIT bleeding risk scores in atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants: a report from the ESC-EHRA EORP-AF General Long-Term Registry

Proietti

Romiti

Vitolo

et al. 2021

European Heart Journal - Quality of Care and Clinical Outcomes

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Introduction Bleeding risk assessment is recommended in guidelines for the management of atrial fibrillation (AF). HAS-BLED score was proposed prior to non-vitamin K antagonist oral anticoagulants (NOACs) and has been suggested that the ORBIT score may be superior in predicting bleeds in NOAC users. We aimed to compare the HAS-BLED and ORBIT scores in contemporary AF patients treated with NOACs. Methods and Results We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. HAS-BLED and ORBIT scores were computed based on original schemes. The primary outcome was the occurrence of Major Bleeding (MB). A total of 3018 patients (median age 70; 39.6% females) were included: median [IQR] HAS-BLED and ORBIT scores were 1 [1–2] and 1 [0–2], respectively; 356 (11.8%) patients were at high risk for MB using HAS-BLED (≥3) and 123 (4.1%) using ORBIT (≥4). Overall, 60 (2.0%) MB events were recorded, with an incidence of 1.1 per 100 patient-years. Both HAS-BLED and ORBIT were associated with outcome, modestly predicting MB (AUC 0.653, 95% CI 0.593–0.714 and AUC 0.601, 95% CI 0.526–0.677, respectively). Calibration plots showed that both scores were poorly calibrated, particularly the ORBIT score, which showed consistent poorer calibration. Time-dependent reclassification analysis showed a trend towards incorrect lower risk reclassification using ORBIT compared to HAS-BLED. Conclusion In this real-life contemporary cohort of AF patients treated with NOACs, the ORBIT score did not provide reclassification improvement, showing even poorer calibration compared to HAS-BLED. Our findings do not support the preferential use of ORBIT in NOAC-treated AF patients.

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Comparison of HAS-BLED with other risk models for predicting the bleeding risk in anticoagulated patients with atrial fibrillation

Cited by 10 publications

References 39 publications

[Retracted] Evaluation of ABC Bleeding Score and SAMe‐TT2R2 Score on the Risk of Bleeding after Anticoagulation in Patients with Nonvalvular Atrial Fibrillation Complicated with Coronary Heart Disease

[Retracted] Evaluation of ABC Bleeding Score and SAMe‐TT2R2 Score on the Risk of Bleeding after Anticoagulation in Patients with Nonvalvular Atrial Fibrillation Complicated with Coronary Heart Disease

Risk of bleeding after ground-level falls in elderly patients with atrial fibrillation and warfarin therapy

Comparison of HAS-BLED and ORBIT bleeding risk scores in atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants: a report from the ESC-EHRA EORP-AF General Long-Term Registry

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