Physician practices regarding contraindications to oral anticoagulation in atrial fibrillation: Findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry

O’Brien, Emily C.; Holmes, DaJuanicia N.; Ansell, Jack; Allen, Larry A.; Hylek, Elaine M.; Kowey, Peter R.; Gersh, Bernard J.; Fonarow, Gregg C.; Koller, Christopher; Ezekowitz, Michael D.; Mahaffey, Kenneth W.; Chang, Paul; Peterson, Eric D.; Piccini, Jonathan P.; Singer, Daniel E.

doi:10.1016/j.ahj.2013.12.014

Cited by 148 publications

(111 citation statements)

References 22 publications

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“…Data from the ORBIT‐AF (Outcomes Registry for Better Informed Treatment of AF) study show that history of bleeding was one of the most prevalent reasons for not prescribing OACs,24 as well as for OAC discontinuation 25…”

Section: Discussionmentioning

confidence: 99%

Predicting Bleeding Events in Anticoagulated Patients With Atrial Fibrillation: A Comparison Between the HAS‐BLED and GARFIELD‐AF Bleeding Scores

Proietti

Rivera‐Caravaca

Esteve-Pastor

et al. 2018

JAHA

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BackgroundPatients with atrial fibrillation (AF) treated with oral anticoagulants may be exposed to an increased risk of bleeding events. The HAS‐BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INRs, Elderly, Drugs or alcohol) score is a simple, well‐established, clinical bleeding‐risk prediction score. Recently, a new algorithm‐based score was proposed, the GARFIELD‐AF (Global Anticoagulant in the Field–AF) bleeding score. We compared HAS‐BLED and GARFIELD‐AF scores in predicting adjudicated bleeding events in a clinical trial cohort of patients with AF taking anticoagulants, in the first external comparative validation of both scores.Methods and ResultsWe analyzed patients from the SPORTIF (Stroke Prevention Using an Oral Thrombin Inhibitor in Patients With AF) III and V trials. All patients assigned to the warfarin arm with information to calculate the scores were considered. Outcomes were major, major/clinically relevant nonmajor, and any bleeding. A total of 3550 warfarin‐treated patients were available for analysis. Of these patients, 2519 (71.0%) had a HAS‐BLED score ≥3, whereas based on GARFIELD‐AF median value, 2056 (57.9%) were categorized as “high score.” Both HAS‐BLED and GARFIELD‐AF C‐indexes showed modest predictive value (C‐index [95% confidence interval] for major bleeding, 0.58 [0.56–0.60] and 0.56 [0.54–0.57], respectively); however, GARFIELD‐AF was not predictive of any bleeding. The GARFIELD‐AF bleeding score had a significantly lower sensitivity and a negative reclassification for any bleeding compared with HAS‐BLED, assessed by integrated discrimination improvement and net reclassification improvement (both P<0.001). HAS‐BLED showed a 5% net benefit for any bleeding occurrence.ConclusionsThe algorithm‐based GARFIELD‐AF bleeding score did not show any significant improvement in major and major/clinically relevant nonmajor prediction compared with the simple HAS‐BLED score. For clinical usefulness in prediction of any bleeding, the HAS‐BLED score showed a significant net benefit compared with the GARFIELD‐AF.

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Section: Discussionmentioning

confidence: 99%

Predicting Bleeding Events in Anticoagulated Patients With Atrial Fibrillation: A Comparison Between the HAS‐BLED and GARFIELD‐AF Bleeding Scores

Proietti

Rivera‐Caravaca

Esteve-Pastor

et al. 2018

JAHA

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“…Mimo tych dowodów niedostateczne stosowanie lub przedwczesne przerywanie OAC wciąż jest częste. Do najczęstszych przyczyn wstrzymywania się z OAC lub przerywania go należą incydenty krwotoczne -zarówno poważne, jak i jedynie kłopotliwe -postrzegane "duże ryzyko krwawienia" podczas stosowania OAC, a także wysiłki, które trzeba włożyć w monitorowanie i modyfikowanie leczenia za pomocą VKA [352,[355][356][357][358][359]. Znaczne ryzyko udaru mózgu bez OAC jest jednak często większe niż ryzyko krwawienia podczas stosowania OAC, nawet u osób w podeszłym wieku, pacjentów z dysfunkcją poznawczą oraz pacjentów często upadających lub z zespołem kruchości [360,361].…”

Section: Definiowanie Celów Leczeniaunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,401

4,206

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“…A recent study has demonstrated that contraindications are common but subjective, not only including prior bleeds, recent surgery and patient's refusal, but also high bleeding risk, frequent falls and frailty, which are not true contraindications to OAT [27]. In a prospective observational study on older medical in-patients with AF we observed a 16% prevalence of major contraindications to OAT [6], whereas in a sample of AF patients discharged from a geriatric ward, permanent or temporary contraindications to OAT were observed in 24% of them [7].…”

Section: Impact Of Contraindicationsmentioning

confidence: 99%

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence

Grisoglio

Brunetti

et al. 2017

European Journal of Internal Medicine

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Physician practices regarding contraindications to oral anticoagulation in atrial fibrillation: Findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry

Cited by 148 publications

References 22 publications

Predicting Bleeding Events in Anticoagulated Patients With Atrial Fibrillation: A Comparison Between the HAS‐BLED and GARFIELD‐AF Bleeding Scores

Predicting Bleeding Events in Anticoagulated Patients With Atrial Fibrillation: A Comparison Between the HAS‐BLED and GARFIELD‐AF Bleeding Scores

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence

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