Comparison of Risk-Scoring Models to Predict Gastrointestinal Bleeding in Patients With Direct Oral Anticoagulants

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Direct oral anticoagulants (DOACs) are widely used for anticoagulation.
• Gastrointestinal bleeding (GIB) is a significant adverse event associated with DOACs.
• Accurate prediction of GIB risk is crucial for patient safety.

Purpose of the Study:

• To evaluate the efficacy of four established risk-scoring models (HAS-BLED, ATRIA, VTE-BLEED, ORBIT) in predicting GIB.
• To assess how the concomitant use of antiplatelet therapy affects the predictive performance of these models in DOAC users.

Main Methods:

• A retrospective study of 4494 patients prescribed DOACs between December 2014 and October 2020.
• Comparison of the predictive performance (AUROC, likelihood ratios) of four GIB risk-scoring models.
• Stratification of analysis based on the concurrent use of antiplatelet therapy.

Main Results:

• All four models (HAS-BLED, ATRIA, VTE-BLEED, ORBIT) demonstrated moderate predictive performance (AUROC range: 0.643-0.709).
• Predictive accuracy, specificity, and AUROC values were significantly higher for all models in patients *not* receiving antiplatelet therapy.
• Performance decreased in the subgroup of DOAC users also taking antiplatelet agents.

Conclusions:

• Existing risk-scoring models for GIB in DOAC users show diminished accuracy when antiplatelet therapy is concurrently used.
• The findings highlight a critical limitation in current GIB risk stratification tools.
• Future risk prediction models for DOAC-associated GIB should integrate antiplatelet therapy status for enhanced diagnostic accuracy.