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Modified HAS-BLED score for predicting delayed intracranial hemorrhage in DOAC-treated geriatric head trauma
1Mardin Artuklu University Faculty of Medicine, Department of Emergency Medicine, 47200 Mardin, Turkiye.
Insights
The modified HAS-BLED score can predict delayed intracranial hemorrhage (DICH) in elderly patients on direct oral anticoagulants (DOACs) after head trauma. This score aids in deciding whether repeat imaging is necessary, improving patient care.
Area of Science:
- Geriatric Medicine
- Neurology
- Pharmacology
Background:
- Elderly patients on direct oral anticoagulants (DOACs) face risks of delayed intracranial hemorrhage (DICH) post-head trauma, even with normal initial CT scans.
- Current guidelines lack clarity on observation periods and repeat imaging protocols for these patients.
- This study investigates the utility of the modified HAS-BLED score for predicting DICH and guiding follow-up imaging decisions.
Purpose of the Study:
- To evaluate the modified HAS-BLED score's effectiveness in predicting DICH in geriatric patients on DOACs after head trauma.
- To determine if the score can inform decisions regarding repeat cranial CT imaging.
Main Methods:
- A retrospective cohort study of 472 geriatric patients (≥65 years) on DOACs with blunt head trauma and normal initial CT scans.
- Extraction of clinical and laboratory data, including calculation of the modified HAS-BLED score.
- Analysis using multivariable logistic regression and Receiver Operating Characteristic (ROC) curves to assess predictive performance.
Main Results:
- DICH occurred in 4.7% of patients.
- The modified HAS-BLED score was significantly higher in patients who developed DICH and was an independent predictor.
- ROC analysis showed an AUC of 0.878; a cut-off score of ≥3 yielded 90.9% sensitivity and 75.3% specificity.
Conclusions:
- The modified HAS-BLED score is a robust predictor of DICH in elderly DOAC users with head trauma.
- This score can facilitate early risk stratification, supporting selective repeat imaging instead of routine protocols.
Background:
Geriatric patients receiving direct oral anticoagulants (DOACs) are at risk of delayed intracranial hemorrhage (DICH) after head trauma despite an initially normal cranial CT. Clear guidance on observation and repeat imaging is lacking. This study evaluated the clinical utility of the modified HAS-BLED score for predicting DICH and informing follow-up imaging decisions.
Methods:
This retrospective cohort study included 472 patients aged ≥65 years who were receiving DOACs, presented with blunt head trauma, and had a normal initial cranial CT. Clinical and laboratory data were extracted from electronic records. The modified HAS-BLED score was calculated for each patient. The primary outcome was DICH detected on follow-up imaging. Multivariable logistic regression and ROC analyses were performed.
Results:
Delayed intracranial hemorrhage (DICH) occurred in 22 patients (4.7%). Patients with DICH were older and had lower eGFR and higher INR levels in univariate analysis. The modified HAS-BLED score was significantly higher in patients who developed DICH and remained an independent predictor in multivariable analysis. ROC analysis demonstrated good discriminative performance, with an AUC of 0.878 (95% CI 0.806-0.931), and a cut-off value of ≥3 provided a sensitivity of 90.9% and a specificity of 75.3% with a high negative predictive value for identifying low-risk patients.
Conclusion:
The modified HAS-BLED score is a strong independent predictor of delayed intracranial hemorrhage in geriatric DOAC users with head trauma. It may serve as a practical tool for early risk stratification, supporting selective rather than routine repeat imaging.