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Published on: February 26, 2013
Expanded Application of the DOAC Score for Predicting Bleeding Events in All Anticoagulated Patients With Atrial
Shunsuke Kuroda1, Katsumi Miyauchi1, Sakiko Miyazaki1
1Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine Tokyo Japan.
Insights
The DOAC score shows moderate ability to predict major bleeding in atrial fibrillation (AF) patients on oral anticoagulants (OACs). It may offer a unified approach for both DOAC and warfarin users, especially those without prior bleeding history.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Risk Assessment
Background:
- Bleeding risk is a significant concern for patients with atrial fibrillation (AF) receiving oral anticoagulants (OACs).
- The DOAC score was developed for direct oral anticoagulant (DOAC) users, but its utility across all OACs is uncertain.
- Validating the DOAC score in a broader AF population on various OACs is crucial.
Purpose of the Study:
- To validate the DOAC score for predicting major bleeding in patients with AF on any OAC.
- To compare the performance of the DOAC score against the established HAS-BLED score.
Main Methods:
- Analysis of 6,505 patients with nonvalvular AF from two Japanese registries (RAFFINE, SAKURA-AF).
- Evaluation of major bleeding events within one year.
- Comparison of the DOAC score and HAS-BLED score using area under the curve (AUC) and net reclassification improvement (NRI).
Main Results:
- The DOAC score demonstrated a higher AUC (0.653) than HAS-BLED (0.601), though not statistically significant (P=0.23).
- A trend towards improved NRI was observed with the DOAC score (25.4%, P=0.073).
- The DOAC score significantly improved NRI in patients without prior major bleeding (30.9%, P=0.030).
Conclusions:
- The DOAC score exhibits moderate predictive performance for major bleeding in anticoagulated AF patients.
- While not significantly outperforming HAS-BLED in this cohort, the DOAC score's potential applicability to both DOAC and warfarin users suggests a practical, unified risk assessment tool.
- Further validation may support the DOAC score as a versatile instrument for managing bleeding risk in AF patients on OACs.
Background:
Bleeding risk is a concern in patients with atrial fibrillation (AF) on oral anticoagulants (OACs). The DOAC score, a novel bleeding risk score, was developed for patients on direct OACs (DOACs), but its applicability to all anticoagulated patients remains unclear. The aim of this study was to validate the DOAC score in patients with AF who received any OACs.
Methods And Results:
We analyzed data for 6,505 patients with nonvalvular AF receiving OACs from 2 Japanese multicenter registries (RAFFINE, SAKURA-AF; mean age 72±9 years; 28.1% female). Major bleeding occurred in 76 patients within 1 year. The DOAC score was compared to the HAS-BLED score in discrimination ability. The DOAC score showed higher area under the curve (AUC), although the difference was not statistically significant (AUC 0.653 vs. 0.601, P=0.23). The DOAC score also showed a trend towards improved net reclassification over the HAS-BLED score (net reclassification improvement (NRI): 25.4%, P=0.073). In patients without a prior history of major bleeding, the DOAC score offered a significant improvement in the NRI (30.9%, P=0.030).
Conclusions:
The DOAC score demonstrated moderate performance for predicting major bleeding in anticoagulated patients with AF. Although it did not significantly outperform the HAS-BLED score in this study, its applicability to both DOAC and warfarin users may offer a practical, unified approach.
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