Clinical Performance of Bleeding Risk Scores for Predicting Major and Clinically Relevant Non-major Bleeding Events in Patients Receiving Warfarin.
J Thromb Haemost. 2013 Jul 13;
Authors: Burgess S, Crown N, Louzada M, Dresser G, Kim R, Lazo-Langner A
Abstract
BACKGROUND: Oral anticoagulant therapy is associated with an increased risk of hemorrhage which can be assessed by bleeding risk scores. We evaluated the performance of 5 validated scores for predicting major and clinically relevant non-major bleeding events in patients receiving warfarin.
METHODS AND RESULTS: We conducted an ambispective, single-center cohort study of 321 consecutive patients enrolled in an academic anticoagulation clinic. The following scores were calculated: modified Outpatient Bleeding Risk Index, Contemporary Bleeding Risk Model, HEMORR2 HAGES, HAS-BLED, and ATRIA. Main outcomes were major bleeding and a composite of major plus clinically relevant non major bleeding. Incidence rates for all group were 3.8 (95% CI 2.0-6.4), and 11.9 (95% CI 8.6-16.4) events per 100 patient-years for major bleeding and major plus clinically relevant non major bleeding, respectively. Agreement among the 5 scores was low to moderate (Kendall's tau-b coefficients 0.22-0.54). For major bleeding the c-statistics ranged from 0.606 to 0.735 whereas for major plus clinically relevant non major bleeding they ranged from 0.549 to 0.613. For all scores the 95% CI for the c-statistics crossed 0.5 or was very close. Among high risk patients the HRs for major bleeding ranged from 0.90 to 39.01 whereas for major plus clinically relevant non major bleeding they ranged from 1.52 to 8.71. For intermediate risk patients no score, except the Contemporary Bleeding Risk Model, produced statistically significant HRs.
CONCLUSION: The scores demonstrated poor agreement and low to moderate discriminatory ability. General clinical implementation of these scores cannot be recommended yet. This article is protected by copyright. All rights reserved.
PMID: 23848301 [PubMed - as supplied by publisher]