The HAS-BLED score has better prediction accuracy for major bleeding than the CHADS2 or CHA2DS2-VASc scores In anticoagulated patients with atrial fibrillation.
J Am Coll Cardiol. 2013 Sep 13;
Authors: Roldán V, Marín F, Manzano-Fernández S, Gallego P, Vílchez JA, Valdés M, Vicente V, Lip GY
Abstract
OBJECTIVES: To test the hypothesis that a specific bleeding risk score, HAS-BLED was better at predicting major bleeding compared to CHADS2 and CHA2DS2-VASc in anticoagulated atrial fibrillation (AF) patients.
BACKGROUND: The CHADS2 and CHA2DS2-VASc scores are well-validated stroke risk prediction scores for AF, but are also associated with increased bleeding and mortality.
METHODS: We recruited 1370 consecutive AF patients (49% male; median age 76) on OAC from our out-patient anticoagulation clinic, all of whom were anticoagulated with acenocoumarol and had an INR between 2.0 and 3.0 during the preceding 6 months. During follow-up, major bleeding events were identified by the 2005 International Society on Thrombosis and Haemostasis (ISTH) criteria. Model performance was evaluated by calculating c-statistics, and the improvement in predictive accuracy was evaluated by calculating the net reclassification improvement(NRI) and integrated discrimination improvement(IDI).
RESULTS: After a median follow-up of 996 (802-1254) days, 114 (3.0%/year) presented with a major bleeding event; of these, 31 were intracranial haemorrhages (0.8%/year). Based on c-statistics, HAS-BLED had a superior model performance to both CHADS2 and CHA2DS2-VASc (both p<0.001). Both NRI and IDI analyses also show that HAS-BLED was more accurately associated with major bleeding compared to CHADS2 and CHA2DS2-VASc scores.
CONCLUSION: In anticoagulated AF patients, a validated specific bleeding risk score, HAS-BLED, should be used for assessing major bleeding. The practice of using CHADS2 and CHA2DS2-VASc as a measure of high bleeding risk should be discouraged, given its inferior predictive performance to the HAS-BLED score.
PMID: 24055744 [PubMed - as supplied by publisher]