Predictive Value of the HAS-BLED and ATRIA Bleeding Scores for the Risk of Serious Bleeding in a “Real-World” Population With Atrial Fibrillation Receiving Anticoagulant Therapy

Roldán, Vanessa; Marı́n, Francisco; Fernández, Hermógenes; Manzano‐Fernández, Sergio; Gallego, Pilar; Valdés, Mariano; Vicente, Vicente; Lip, Gregory Y.H.

doi:10.1378/chest.12-0608

Cited by 187 publications

(146 citation statements)

References 17 publications

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“…In particular, high‐risk patients (HAS‐BLED score ≥3) have a significantly higher risk of major bleeding, as demonstrated in several studies 31, 40. In a Spanish real‐world cohort, for example, a HAS‐BLED score ≥3 demonstrated significant predictive ability (C‐index [95% CI], 0.68 [0.65–0.71]) 31. Similar data, derived from the Loire Valley AF Project, showed that patients with a HAS‐BLED score ≥3 reported a higher rate of major bleeding, with a significantly increased risk (hazard ratio, 3.57; 95% CI, 2.59–4.92) compared with patients with a HAS‐BLED score of 2 and a HAS‐BLED score of 0 to 1 40…”

Section: Discussionmentioning

confidence: 78%

“…These studies all demonstrate a modest predictive capacity for these clinical bleeding risk scores, although most analyses reported that the HAS‐BLED score performs best 31, 36, 38. In particular, high‐risk patients (HAS‐BLED score ≥3) have a significantly higher risk of major bleeding, as demonstrated in several studies 31, 40. In a Spanish real‐world cohort, for example, a HAS‐BLED score ≥3 demonstrated significant predictive ability (C‐index [95% CI], 0.68 [0.65–0.71]) 31.…”

Section: Discussionmentioning

confidence: 84%

“…Thus far, the HAS‐BLED score has been validated in several cohorts and is able to predict major bleeding in various clinical settings 31, 32, 33, 34. Several studies reported about the comparison between HAS‐BLED and other bleeding risk scores in vitamin K antagonist‐treated cohorts 31, 35, 36, 37, 38, 39.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies reported about the comparison between HAS‐BLED and other bleeding risk scores in vitamin K antagonist‐treated cohorts 31, 35, 36, 37, 38, 39. These studies all demonstrate a modest predictive capacity for these clinical bleeding risk scores, although most analyses reported that the HAS‐BLED score performs best 31, 36, 38. In particular, high‐risk patients (HAS‐BLED score ≥3) have a significantly higher risk of major bleeding, as demonstrated in several studies 31, 40.…”

Section: Discussionmentioning

confidence: 99%

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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: 78%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“…uncontrolled blood pressure (the 'H' in HAS-BLED) and labile INRs if on warfarin (the 'L' in HAS-BLED)]. Also, the HAS-BLED score has been shown to outperform other bleeding risk assessment schemes (including the new ATRIA score) in its predictive value for serious bleeding events (15).…”

mentioning

confidence: 99%

Peri-procedural antithrombotic bridging and the assessment of the associated risk of major bleeding

Limantoro¹,

Pisters²

2012

Thromb Haemost

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International Validity of the HOSPITAL Score to Predict 30-Day Potentially Avoidable Hospital Readmissions

et al. 2016

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Predictive Value of the HAS-BLED and ATRIA Bleeding Scores for the Risk of Serious Bleeding in a “Real-World” Population With Atrial Fibrillation Receiving Anticoagulant Therapy

Cited by 187 publications

References 17 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

Peri-procedural antithrombotic bridging and the assessment of the associated risk of major bleeding

International Validity of the HOSPITAL Score to Predict 30-Day Potentially Avoidable Hospital Readmissions

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