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ABS20200616_0001
| Complications | |
| Performance of the HAS-BLED, ATRIA, and PRECISE-DAPT Bleeding Risk Scores in Atrial Fibrillation Patients Using Antiplatelet Agents or Oral Anticoagulants | |
| Sun Young Choi1, Guangxi Yuan2, Moo Hyun Kim3, Kwang-Min Lee1 | |
| Dong-A University Medical Center, Korea (Republic of)1, DONG-A University Hospital, China2, Dong-A University Hospital, Korea (Republic of)3 | |
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Background:
Various bleeding risk scores have been proposed to assess the risk of bleeding inatrial fibrillation (AF) patients undergoing anticoagulation. PRECISE DAPTscore has been developed to assess the out-of hospital bleeding risk inpatients receiving dual antiplatelet therapy (DAPT). Our objective was to comparethe predictive performance between the HAS-BLED (Hypertension, AbnormalRenal/Liver Function, Stroke, Bleeding History or Predisposition, LabileInternational Normalized Ratio, Elderly, Drugs/Alcohol), ATRIA (Anticoagulationand Risk Factors in Atrial Fibrillation), and PRECISE-DAPT (Predicting BleedingComplication in Patients Undergoing Stent Implantation and Subsequent DualAntiplatelet therapy) score in AF patients using antiplatelet agents or anticoagulants.
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Methods:
We recruited 1,114consecutive AF patients (51% male; median age, 71 years) receiving antiplateletagents or oral anticoagulants from January 2014 through December 2018. The HAS-BLED, ATRIA, and PRECISE-DAPT bleeding risk scores were calculated from patients¡¯ clinical characteristics. Majorbleeding was defined as according to the Bleeding Academic Research Consortium(BARC) criteria (type 3 or 5: hemodynamic instability, need for transfusion,drop in hemoglobin ¡Ã 3 g, and intracranial, intraocular or fatal bleeding). Theperformance of risk scores were assessed by C-statistic.
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Results:
Bleeding events occurred in 72 patients (6.5%) from 30 days till1-year follow-up. Based on the C-statistic, PRECISE-DAPT score (AUC: 0.70, 95%CI: 0.67-0.72) and ATRIA score (AUC: 0.69, 95% CI: 0.66-0.72) had a good performance, significantly better than HAS-BLED (AUC:0.64, 95% CI: 0.61-0.67) (p = 0.03). And, PRECISE-DAPT score was similar to ATRIA score in predicting bleeding events.
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Conclusion:
All 3 bleeding risk scores demonstrated onlymodest performance in predicting 12-month bleedings in Korean AF patientsreceiving antiplatelet agents or oral anticoagulant (warfain or NOAC), althoughthe predictive ability of HAS-BLED score was not superior to ATRIA, andPRECISE-DAPT scores. PRECISE-DAPT score for DAPT can be used as bleeding riskscore in AF patients with HAS-BLED, ATRIA and PRECISE-DAPT score.
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