Accuracy of HAS-BLED and BleedMAP Scores in Predicting Postoperative Bleeding in Anticoagulated Patients Undergoing...

BackgroundThere are limited data on the performance of bleeding risk scores in predicting postoperative bleeding in anticoagulated patients undergoing elective non-cardiac surgery.ObjectivesTo evaluate the predictive accuracy of the HAS-BLED and BleedMAP scores for postoperative bleeding risk in this population.MethodsThis retrospective study enrolled anticoagulated patients undergoing elective surgery referred to the Preoperative Medical Consultation clinic. The C-statistic was used to evaluate the discriminatory performance of the HAS-BLED and BleedMAP scores in predicting overall bleeding following non-cardiac surgery. The predictive performance of the two scores was compared using DeLong's method.ResultsAmong 591 patients who had previously received anticoagulation therapy, 84.9% received warfarin, 9.5% enoxaparin, and 5.6% direct oral anticoagulants. Indications included atrial fibrillation (67.9%), venous thromboembolism (18.1%), and mechanical valve replacement (13.5%). Procedures were classified as minor (16.6%), low to moderate risk (46.4%), or high bleeding risk (37.1%). The mean HAS-BLED and BleedMAP scores were 2.35 ± 1.36 and 0.94 ± 0.81, respectively. At 1-month postoperative follow-up, the overall bleeding rate was 40.4%, with 2.5% classified as major bleeding events. The HAS-BLED score had a C-statistic of 0.512 (95% confidence intervals (CI): 0.434-0.591) for predicting overall bleeding, while the BleedMAP score showed moderate predictive ability (C-statistic: 0.581; 95% CI: 0.531-0.631). The two scores had no statistically significant difference (P = .13).ConclusionsThe HAS-BLED score showed limited discriminatory ability for postoperative bleeding in anticoagulated patients, though its negative predictive value was high. No significant difference in predictive performance was observed between the HAS-BLED and BleedMAP scores.