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[Predictive value of four score systems on the bleeding risk in atrial fibrillation patients treated with dabigatran]
1Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China.
Insights
The HAS-BLED score better predicts bleeding risk in Chinese patients with nonvalvular atrial fibrillation (NVAF) on dabigatran compared to other scores, though its overall predictive value remains limited.
Area of Science:
- Cardiology
- Pharmacology
- Medical Informatics
Background:
- Nonvalvular atrial fibrillation (NVAF) necessitates anticoagulant therapy, often with dabigatran.
- Accurate prediction of bleeding risk is crucial for managing patients on anticoagulants.
- Several risk scores exist, but their comparative performance in specific populations requires evaluation.
Purpose of the Study:
- To compare the predictive accuracy of four bleeding risk scores: HAS-BLED, HEMORR2HAGES, ATRIA, and ORBIT.
- To assess these scores in Chinese patients with NVAF treated with dabigatran.
- To determine the most effective score for predicting bleeding events in this cohort.
Main Methods:
- A prospective, non-interventional study involving 942 NVAF patients treated with dabigatran in China.
- Data collection included baseline characteristics and bleeding risk scores (HAS-BLED, HEMORR2HAGES, ATRIA, ORBIT).
- Bleeding events were monitored over a 6-month follow-up period; Cox models and ROC curves (AUC) were used for analysis.
Main Results:
- A total of 93 bleeding events (9.9%) were recorded during follow-up.
- The HAS-BLED score demonstrated superior predictive value (AUC=0.558) compared to HEMORR2HAGES (AUC=0.520), ATRIA (AUC=0.513), and ORBIT (AUC=0.523).
- High-risk HAS-BLED scores significantly correlated with increased bleeding risk (HR=2.87), unlike the other scores.
Conclusions:
- The HAS-BLED score is more effective than HEMORR2HAGES, ATRIA, and ORBIT in predicting bleeding risk in Chinese NVAF patients on dabigatran.
- Despite being superior, the overall predictive capability of the HAS-BLED score in this population is considered relatively low.
- Further research may be needed to refine bleeding risk prediction models for dabigatran users in this demographic.
Abstract:
Objective: To compare the predictive value of HAS-BLED, HEMORR2HAGES, ATRIA and ORBIT scores on the bleeding risk in nonvalvular atrial fibrillation (NVAF) patients treated with dabigatran. Methods: Data of 942 NVAF patients participating a non-interventional prospective study of anticoagulant therapy with dabigatran, which was conducted in 12 centers from February 2015 to December 2017 in China, were analyzed. Complete HAS-BLED HEMORR2HAGES, ATRIA and ORBIT bleeding risk scores data and follow-up data were available in the enrolled patients. The endpoint of the study was bleeding events occurred during a 6 months follow-up. Cox proportional hazards models were constructed to analyze the associations between HAS-BLED, HEMORR2HAGES, ATRIA and ORBIT scores and risk of bleeding, and the area under the curve (AUC) of receiver operating characteristics curves (ROC) of each score was used to set the predictive value for bleeding risk. Results: Among the 942 patients, the mean age was (65.3±11.2) years old, 542 (57.5%) were males. A total of 93 (9.9%) bleeding events occurred during follow up, 89 (9.4%) events were minor bleeding, and 4 (0.4%) events were major bleeding. Patients with a high-risk HAS-BLED score had a 1.87-fold increased risk of bleeding compared with low-risk patients (HR = 2.87, 95% CI:1.26-6.51, P = 0.012). There was no statistically significant difference between low-medium-high-risk grading in other scoring systems and bleeding risk (all P>0.05). The AUC (95%CI) of HAS-BLED, HEMORR2HAGES, ATRIA and ORBIT bleeding risk scores were 0.558 (0.525-0.590), 0.520 (0.487-0.553), 0.513(0.480-0.545), 0.523(0.490-0.555), respectively. The AUC of all bleeding score systems were of ≤ 0.700. Conclusion: Among the NVAF patients taking dabigatran in China, the HAS-BLED bleeding risk score is superior to other 3 bleeding risk score on predicting the bleeding risk in these patients, but its predictive value is still relatively low.
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