Revised HAS-BLED score for bleeding prediction in atrial fibrillation patients with oral anticoagulants

There were several limitations to the original HAS-BLED (oHAS-BLED) score in patients with atrial fibrillation (AF). This trial studied the revised HAS-BLED (rHAS-BLED) score for predicting bleeding events in anticoagulated AF patients.

This study retrospectively recruited anticoagulated AF patients in the Central Chest Institute of Thailand between 2014 and 2021. The rHAS-BLED score was oHAS-BLED using the estimated glomerular filtration rate of <60 ml/min/1.73 m² for abnormal renal function, SAMe-TT₂R₂ score of ≥3 for labile INR, and adding clinically relevant nonmajor bleeding (CRNMB) into bleeding history. The outcome was major bleeding (MB) and/or CRNMB at 1-year follow-up visit. The outcome between both groups was compared by using the chi-square test or Fisher's exact test. Receiver-operating characteristics curve was used to analyze the discrimination performances of both scores and the results were illustrated by using c-statistics.

A total of 256 anticoagulated AF patients were enrolled. The average age was 73.6 ± 10.1 years. The average oHAS-BLED and rHAS-BLED scores were 1.7 ± 0.9 and 2.6 ± 1.2, respectively. Twenty patients in rHAS-BLED ≥3 (15.9%) and 9 patients in rHAS-BLED <3 (6.9%) experienced MB and/or CRNMB. The rHAS-BLED score of ≥3 increased the bleeding risk with statistical significance (OR 2.54, 95% CI 1.11-5.81, p = .04). The discriminative performance of the rHAS-BLED score was illustrated with c-statistics of 0.61 (95% CI 0.50-0.71).

The rHAS-BLED score could predict bleeding events in anticoagulated AF patients. However, a larger study is needed to confirm these results in the future.