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Clinical Outcomes of Atrial Fibrillation Patients with Increase in HAS-BLED Score and Discontinue Oral Anticoagulants

Voravut Rungpradubvong1,2, Gregory Yh Lip3,4,5, Rungroj Krittayaphong6

  • 1Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Thrombosis and Haemostasis
|February 24, 2026
PubMed

Insights

Discontinuing oral anticoagulants (OACs) after a higher HAS-BLED score increases risks for mortality and major bleeding. Focus on optimizing patient risk, not stopping OAC therapy, for better outcomes in AF patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Atrial fibrillation (AF) patients on oral anticoagulants (OACs) face risks that may increase over time.
  • The HAS-BLED score is used to assess bleeding risk in these patients.
  • Understanding the impact of OAC discontinuation after a HAS-BLED score increase is crucial for patient management.

Purpose of the Study:

  • To investigate the association between oral anticoagulant (OAC) discontinuation and patient outcomes following an increase in the HAS-BLED score.
  • To determine if OAC cessation impacts composite endpoints including mortality, stroke, and major bleeding.
  • To inform clinical practice regarding OAC management in AF patients with rising bleeding risk scores.

Main Methods:

  • Analysis of 1,030 patients from the prospective, multicenter COOL-AF registry on OACs at baseline.
  • Categorization into OAC continuation (n=936) or discontinuation (n=94) groups upon HAS-BLED score increase.
  • Use of multivariable Cox regression and propensity score matching (1:2) to adjust for confounders and assess primary composite outcomes (all-cause mortality, stroke/systemic embolism, major bleeding).

Main Results:

  • OAC discontinuation was linked to significantly higher event rates (20.2 vs 7.9 per 100 person-years; p < 0.001) during a median 23.7-month follow-up.
  • Discontinuation independently associated with increased risk of composite endpoint (aHR 2.65), all-cause mortality (aHR 3.66), and major bleeding (aHR 2.60).
  • No significant difference in stroke/systemic embolism was observed between groups, potentially due to competing risks or residual confounding.

Conclusions:

  • Oral anticoagulant discontinuation following a HAS-BLED score increase is associated with worse patient outcomes.
  • The observed association may reflect residual confounding rather than a direct causal effect of stopping OACs.
  • Clinical decisions should prioritize risk optimization strategies over automatic cessation of OAC therapy in AF patients.

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