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DOAC score among patients receiving Vitamin K antagonists

Rahul Aggarwal1, Christian T Ruff2, Michael G Palazzolo2

  • 1Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

American Heart Journal
|June 23, 2026
PubMed

Insights

The DOAC Score effectively stratifies bleeding risk in atrial fibrillation patients on vitamin K antagonists, outperforming the HAS-BLED score. This bleeding risk assessment tool aids in managing anticoagulation therapy.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Risk Stratification

Background:

  • The DOAC Score is a validated bleeding risk assessment tool for patients on direct-acting oral anticoagulants (DOACs).
  • Existing scores like HAS-BLED have limitations in specific patient populations.
  • This study investigates the DOAC Score's utility in patients taking vitamin K antagonists (VKAs).

Purpose of the Study:

  • To evaluate the discriminative performance of the DOAC Score in patients with atrial fibrillation (AF) treated with VKAs.
  • To compare the DOAC Score's effectiveness against the HAS-BLED score in this patient cohort.

Main Methods:

  • Utilized data from the COMBINE-AF and GARFIELD-AF studies, including patients on VKAs.
  • Calculated DOAC Scores and stratified patients into risk categories.
  • Assessed one-year major bleeding rates and discrimination using C-statistics, comparing DOAC Score with HAS-BLED.

Main Results:

  • Included over 49,000 patients on VKAs across both cohorts.
  • Higher DOAC Score categories correlated with increased one-year major bleeding rates in both COMBINE-AF and GARFIELD-AF.
  • The DOAC Score demonstrated moderate discrimination, outperforming HAS-BLED in both studies (C-statistics: 0.62 vs 0.59 in COMBINE-AF; 0.65 vs 0.62 in GARFIELD-AF).

Conclusions:

  • The DOAC Score effectively stratifies bleeding risk in atrial fibrillation patients on VKAs.
  • The DOAC Score exhibits moderate discriminative ability and superior performance compared to HAS-BLED in this population.
  • This suggests the DOAC Score is a valuable tool for managing bleeding risk in VKA-treated AF patients.
Abstract

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