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Published on: February 26, 2013
Performance of bleeding risk-prediction scores in patients with atrial fibrillation undergoing percutaneous coronary
Tuomas Kiviniemi1, Marja Puurunen2, Axel Schlitt3
1Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
Insights
Validated bleeding risk scores like HAS-BLED and ATRIA proved ineffective in predicting bleeding complications for atrial fibrillation patients undergoing percutaneous coronary intervention (PCI). These tools were useless in this high-risk population receiving multiple antithrombotic drugs.
Area of Science:
- Cardiology
- Clinical Pharmacology
Background:
- Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) often receive multiple antithrombotic drugs.
- Assessing bleeding risk in this population is crucial but challenging.
Purpose of the Study:
- To compare the predictive performance of established bleeding risk-prediction tools in AF patients post-PCI.
- To evaluate the utility of HAS-BLED, ATRIA, mOBRI, and REACH scores in this specific high-risk cohort.
Main Methods:
- A multicenter European prospective registry included 929 consecutive AF patients undergoing PCI.
- HAS-BLED, ATRIA, mOBRI, and REACH scores were calculated.
- Bleeding complications were assessed at 12-month follow-up using Bleeding Academic Research Consortium criteria.
Main Results:
- Increasing age, femoral access, and prior peptic ulcer independently predicted bleeding.
- Low-risk scores were identified in varying percentages across the tools (e.g., ATRIA 73.0%, REACH 5.7%).
- No significant differences in bleeding rates were found between low and intermediate/high scores for any tool.
Conclusions:
- Established bleeding risk-prediction tools (ATRIA, HAS-BLED, mOBRI, REACH) demonstrated useless predictive performance in AF patients receiving multiple antithrombotics after PCI.
- These scores are not reliable for managing bleeding risk in this complex patient subset.
Abstract:
The hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, and drugs/alcohol (HAS-BLED); anticoagulation and risk factors in atrial fibrillation (ATRIA); modified Outpatient Bleeding Risk Index (mOBRI); and reduction of atherothrombosis for continued health (REACH) schemes are validated bleeding risk-prediction tools, but their predictive performance in patients with AF receiving multiple antithrombotic drugs after percutaneous coronary intervention (PCI) is unknown. We sought to compare the predictive performance of bleeding risk-estimation tools in a cohort of patients with atrial fibrillation (AF) undergoing PCI. Management of patients with AF undergoing coronary artery stenting is a multicenter European prospective registry enrolling patients with AF undergoing PCI. We calculated HAS-BLED, ATRIA, mOBRI, and REACH bleeding risk-prediction scores and assessed the rate of bleeding complications as defined by Bleeding Academic Research Consortium at 12 months follow-up in 929 consecutive patients undergoing PCI. Increasing age, femoral access site, and previous peptic ulcer were independent determinants of bleeding. Low bleeding risk scores as determined by HAS-BLED 0 to 2, ATRIA 0 to 3, mOBRI 0, and REACH 0 to 10 were detected in 23.7%, 73.0%, 7.8%, and 5.7% of patients of the cohort, respectively. No significant differences were detected in the rates of any bleeding or major bleeding events for low versus intermediate/high scores with each risk-prediction tool. In conclusion, the performance of ATRIA, HAS-BLED, mOBRI, and REACH scores in predicting bleeding complications in this high-risk patient subset was useless.
