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Comparison of the CHADS-VASc, CHADS, HAS-BLED, ORBIT, and ATRIA Risk Scores in Predicting Non-Vitamin K Antagonist Oral Anticoagulants-Associated Bleeding in Patients With Atrial Fibrillation.

作者信息

Yao Xiaoxi, Gersh Bernard J, Sangaralingham Lindsey R, Kent David M, Shah Nilay D, Abraham Neena S, Noseworthy Peter A

机构信息

Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.

Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.

出版信息

Am J Cardiol. 2017 Nov 1;120(9):1549-1556. doi: 10.1016/j.amjcard.2017.07.051. Epub 2017 Jul 31.


DOI:10.1016/j.amjcard.2017.07.051
PMID:28844514
Abstract

The increasing adoption of non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation (AF) necessitates a reassessment of bleeding risk scores. Because known risk factors for bleeding are largely the same as for stroke, we hypothesize that stroke risk scores could also be used to identify patients with high bleeding risks. We aimed to compare the performance of 2 stroke risk scores (Congestive Heart failure, hypertension, Age ≥75 [doubled], Diabetes, Stroke [doubled], Vascular disease, Age 65-74, and Sex [female] [CHADS-VASc] and Cardiac failure, Hypertension, Age, Diabetes, Stroke [Doubled] [CHADS]) and 3 bleeding risk scores (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or predisposition, labile INR, elderly [.65 years], drugs/alcohol concomitantly [1 point each] [HAS-BLED], Outcomes Registry for Better Informed Treatment of Atrial Fibrillation [ORBIT], and AnTicoagulation and Risk factors In Atrial fibrillation [ATRIA]) in predicting major and intracranial bleeding. Using a large US commercial insurance database, we identified 39,539 patients with nonvalvular AF who started NOACs between October 1, 2010 and June 30, 2015. The performance of risk scores was compared using C-statistic and net reclassification improvement (NRI). Over a total of 22,583 person-years, 665 patients (2.94% per year) had major bleeding, including 74 intracranial hemorrhages (0.33% per year). For the prediction of major bleeding, CHADS-VASc had the highest C-statistic both as a continuous score (C-statistic 0.68) and as a categorical score (C-statistic 0.65). For the prediction of intracranial bleeding, CHADS had the highest C-statistic both as a continuous score (C-statistic 0.66) and as a categorical score (C-statistic 0.66). There were no statistically significant differences between scores based on NRI. In conclusion, CHADS-VASc, CHADS, HAS-BLED, ORBIT, and ATRIA had similar, albeit modest, performance in predicting NOAC-associated bleeding in patients with AF. Careful assessment and active management of bleeding risk factors may be warranted in all patients on NOACs who have high stroke risk scores.

摘要

相似文献

[1]
Comparison of the CHADS-VASc, CHADS, HAS-BLED, ORBIT, and ATRIA Risk Scores in Predicting Non-Vitamin K Antagonist Oral Anticoagulants-Associated Bleeding in Patients With Atrial Fibrillation.

Am J Cardiol. 2017-11-1

[2]
The HAS-BLED score has better prediction accuracy for major bleeding than CHADS2 or CHA2DS2-VASc scores in anticoagulated patients with atrial fibrillation.

J Am Coll Cardiol. 2013-9-18

[3]
The predictive ability of the CHADS2 and CHA2DS2-VASc scores for bleeding risk in atrial fibrillation: the MAQI(2) experience.

Thromb Res. 2014-8

[4]
Diagnostic Accuracy of the HAS-BLED Bleeding Score in VKA- or DOAC-Treated Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Front Cardiovasc Med. 2021-11-22

[5]
Comparison of the CHADS2, CHA2DS2-VASc and HAS-BLED scores for the prediction of clinically relevant bleeding in anticoagulated patients with atrial fibrillation: the AMADEUS trial.

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[6]
CHADS-VASc Score for Identifying Truly Low-Risk Atrial Fibrillation for Stroke: A Korean Nationwide Cohort Study.

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[7]
Stroke and bleeding risk co-distribution in real-world patients with atrial fibrillation: the Euro Heart Survey.

Am J Med. 2014-10

[8]
The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation.

Eur Heart J. 2015-12-7

[9]
Comparison of HAS-BLED and HAS-BED Versus CHADS and CHADSVASC Stroke and Bleeding Scores in Patients With Atrial Fibrillation.

Am J Cardiol. 2017-4-1

[10]
The HAS-BLED, ATRIA, and ORBIT Bleeding Scores in Atrial Fibrillation Patients Using Non-Vitamin K Antagonist Oral Anticoagulants.

Am J Med. 2017-12-21

引用本文的文献

[1]
Controversies in Antithrombotic Therapy for Patients With Coronary Artery Disease and Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Literature Review.

Clin Med Insights Cardiol. 2025-8-30

[2]
Edoxaban treatment in routine clinical practice is highly concordant with the 2020 European Society of Cardiology atrial fibrillation guidelines: results from the noninterventional Global ETNA-AF programme.

Eur Heart J Open. 2025-3-28

[3]
Individualised prediction of major bleeding in patients with atrial fibrillation treated with anticoagulation.

PLoS One. 2024

[4]
Periprocedural Edoxaban Management and Clinical Outcomes in Patients Undergoing Transcatheter Cardiovascular Procedures in the EMIT-AF/VTE Program.

Clin Appl Thromb Hemost. 2024

[5]
Intracardiac Echocardiography-guided Left Atrial Appendage Occlusion.

Arrhythm Electrophysiol Rev. 2024-3-12

[6]
Outcomes after TAVI in patients with atrial fibrillation and a history of recent PCI: Results from the ENVISAGE-TAVI AF trial.

Clin Res Cardiol. 2025-3

[7]
Risk scores for major bleeding from direct oral anticoagulants: comparing predictive performance in patients with atrial fibrillation.

Res Pract Thromb Haemost. 2023-11-30

[8]
Construction of a risk scoring system using clinical factors and polymorphisms for bleeding complications in patients on direct oral anticoagulants.

Front Pharmacol. 2023-11-15

[9]
Comparison of bleeding risk scores and evaluation of major bleeding predictive factors in patients with major bleeding due to vitamin K antagonist use.

Heliyon. 2023-8-12

[10]
SAIL study of stroke, systemic embolism and bleeding outcomes with warfarin anticoagulation in non-valvular atrial fibrillation (S-BOW-AF).

Eur Heart J Open. 2023-4-13

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