TY - JOUR
T1 - Comparing Bleeding Risk Assessment Focused on Modifiable Risk Factors Only Versus Validated Bleeding Risk Scores in Atrial Fibrillation
AU - Guo, Yutao
AU - Zhu, Hang
AU - Chen, Yundai
AU - Lip, Gregory Y H
N1 - Copyright © 2018 Elsevier Inc. All rights reserved.
PY - 2018/2
Y1 - 2018/2
N2 - Background: There is uncertainty whether a focus on modifiable bleeding risk factors offers better prediction of major bleeding than other existing bleeding risk scores. Methods: This study compared a score based on numbers of the modifiable bleeding risk factors recommended in the 2016 European guidelines (“European risk score”) versus other published bleeding risk scores that have been derived and validated in atrial fibrillation subjects (HEMORR
2HAGES, HAS-BLED, ATRIA, and ORBIT) in a large hospital-based cohort of Chinese inpatients with atrial fibrillation. Results: The European score had modest predictive ability for major bleeding (c-index 0.63, 95% confidence interval 0.56-0.69) and intracranial hemorrhage (0.72, 0.65-0.79) but nonsignificantly (and poorly) predicted extracranial bleeding (0.55, 0.54-0.56; P =.361). The HAS-BLED score was superior to predict bleeding events compared with the European score, with the differences between c-indexes of 0.10-0.12 (Delong test, all P <.05), net reclassification improvement values of 13.0%-34.5% (all P <.05), and integrated discrimination improvement values of 0.7%-1.4% (all P <.05). The European score had similar predictive value to other bleeding risk schemes (HEMORR
2HAGES, ATRIA, and ORBIT) for major bleeding and intracranial hemorrhage (all P >.05). Decision curve analysis clearly shows that HAS-BLED had better net benefit of predicting major bleeding compared with the European score. Conclusions: Relying on bleeding risk assessment using modifiable bleeding risk factors alone is an inferior strategy for predicting atrial fibrillation patients for major bleeding. Our observations reaffirm the Asian guideline recommendations with HAS-BLED for bleeding risk assessment in patients with atrial fibrillation.
AB - Background: There is uncertainty whether a focus on modifiable bleeding risk factors offers better prediction of major bleeding than other existing bleeding risk scores. Methods: This study compared a score based on numbers of the modifiable bleeding risk factors recommended in the 2016 European guidelines (“European risk score”) versus other published bleeding risk scores that have been derived and validated in atrial fibrillation subjects (HEMORR
2HAGES, HAS-BLED, ATRIA, and ORBIT) in a large hospital-based cohort of Chinese inpatients with atrial fibrillation. Results: The European score had modest predictive ability for major bleeding (c-index 0.63, 95% confidence interval 0.56-0.69) and intracranial hemorrhage (0.72, 0.65-0.79) but nonsignificantly (and poorly) predicted extracranial bleeding (0.55, 0.54-0.56; P =.361). The HAS-BLED score was superior to predict bleeding events compared with the European score, with the differences between c-indexes of 0.10-0.12 (Delong test, all P <.05), net reclassification improvement values of 13.0%-34.5% (all P <.05), and integrated discrimination improvement values of 0.7%-1.4% (all P <.05). The European score had similar predictive value to other bleeding risk schemes (HEMORR
2HAGES, ATRIA, and ORBIT) for major bleeding and intracranial hemorrhage (all P >.05). Decision curve analysis clearly shows that HAS-BLED had better net benefit of predicting major bleeding compared with the European score. Conclusions: Relying on bleeding risk assessment using modifiable bleeding risk factors alone is an inferior strategy for predicting atrial fibrillation patients for major bleeding. Our observations reaffirm the Asian guideline recommendations with HAS-BLED for bleeding risk assessment in patients with atrial fibrillation.
KW - Journal Article
KW - Atrial fibrillation
KW - Risk stratification
KW - HAS-BLED
KW - Bleeding
KW - Risk factors
UR - http://www.scopus.com/inward/record.url?scp=85034448282&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2017.09.009
DO - 10.1016/j.amjmed.2017.09.009
M3 - Journal article
C2 - 28943382
SN - 0002-9343
VL - 131
SP - 185
EP - 192
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 2
ER -