Bleeding Risk Prediction in Non-Valvular Atrial Fibrillation: Comparing Risk Scores in Apixaban- and...

ObjectiveThis study aimed to evaluate the ability of seven bleeding risk assessment tools to predict bleeding events in patients with apixaban or rivaroxaban.MethodsA retrospective analysis was conducted on 313 NVAF patients (apixaban: n = 164; rivaroxaban: n = 149) with at least one year of follow-up at a tertiary hospital in Malaysia. Bleeding risk scores were calculated at treatment initiation using original definitions. Bleeding events were defined according to ISTH criteria. Predictive performance was assessed via area under the receiver operating characteristic (AUROC) curves, with good diagnostic accuracy defined as AUROC ≥ 0.7. Subgroup analyses by age and sex were also performed.ResultsOverall bleeding incidence was 12.46%. Among rivaroxaban users, ORBIT (AUROC 0.68), RE-LY (0.66), and HEMORR₂HAGES (0.66) showed sufficient accuracy. For apixaban users, A4C performed best (AUROC 0.64); HAS-BLED showed no diagnostic value (AUROC 0.42). Some tools showed good subgroup accuracy.ConclusionNone of the bleeding risk assessment tools achieved good overall diagnostic accuracy in NVAF patients treated with apixaban or rivaroxaban. Further studies are needed to validate existing tools and to develop a bleeding risk score with acceptable diagnostic accuracy for this patient population.