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Updated: Apr 26, 2026
Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
A standardized bleeding risk score aligns anticoagulation choices with current evidence
Arielle S Berger1, Andrew S Dunn, Amy S Kelley
1From the *Department of Medicine, Mount Sinai and University Health Network Hospitals, Toronto, ON, Canada; †Department of Medicine, Mount Sinai Hospital, New York,NY; ‡Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; and §Geriatric Research Education and Clinical Centers, James J Peters VA Medical Center, Bronx, New York, NY.
Insights
The HAS-BLED score improved appropriate oral anticoagulation decisions in elderly patients with atrial fibrillation by 18%. This tool helps physicians balance stroke risk and bleeding complications for better patient care.
Area of Science:
- Cardiology
- Geriatrics
- Clinical Decision Support
Background:
- Atrial fibrillation (AF) is a common arrhythmia in the elderly, significantly increasing stroke risk.
- Oral anticoagulation (OAC) effectively reduces stroke risk by 60% but is often underprescribed.
- The HAS-BLED score aids in predicting bleeding complications associated with OAC.
Purpose of the Study:
- To evaluate if the HAS-BLED score improves the appropriateness of OAC decisions in elderly AF patients.
- To assess the impact of the HAS-BLED score on physician decision-making regarding anticoagulation.
Main Methods:
- A survey with clinical vignettes was administered to physicians.
- Physicians were randomized to receive the survey with or without the HAS-BLED score and bleeding risk estimates.
- Appropriate anticoagulation was defined as minimizing stroke and major bleeding risks.
Main Results:
- Physicians using the HAS-BLED score were 18% more likely to make appropriate anticoagulation decisions (74% vs. 56%).
- The score facilitated appropriate anticoagulation initiation and cessation based on risk-benefit analysis.
- Physicians demonstrated poor accuracy in estimating stroke (42%) and bleeding (31%) risks.
Conclusions:
- The HAS-BLED score significantly enhances appropriate OAC prescribing in elderly AF patients.
- Further research is recommended to integrate the HAS-BLED score into real-time clinical practice.
Objectives:
Atrial fibrillation (AF), the most common arrhythmia in elderly patients, accounts for 15% of strokes. Oral anticoagulation (OAC) can reduce the risk of stroke by 60% but is underprescribed. The HAS-BLED score (Hypertension, Abnormal renal or liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs) can predict OAC bleeding complications. The authors hypothesized that use of HAS-BLED can help align decision making with current evidence.
Methods:
The authors developed a survey with four clinical vignettes designed to highlight the complexity in deciding whether to anticoagulate elderly patients with AF. Physicians were randomly assigned to receive the survey either including the HAS-BLED score and the estimated annual risk of bleeding (intervention) or without (control). Following each vignette, participants were asked: (1) whether they would recommend OAC and (2) to estimate the risk of bleeding and stroke. The "appropriate" anticoagulation decision was defined as the choice that minimized the risk of stroke and major bleeding.
Results:
A total of 203 physicians were recruited for the survey, with 55 responses obtained (27%). Physicians who were given the HAS-BLED score were 18% more likely to choose appropriate anticoagulation (74% vs. 56%, P < .05). The HAS-BLED score assisted physicians in both choosing to anticoagulate when appropriate and not to anticoagulate when the risk of bleeding outweighed the benefit. Overall, physicians were poor at estimating the risk of stroke (42% correct) and major bleeding (31% correct).
Conclusions:
Presentation of the HAS-BLED score led to an 18% improvement in appropriate OAC choices. Future study should evaluate incorporation of HAS-BLED use in real-time clinical situations.
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