Revised HAS‐BLED score for bleeding prediction in atrial fibrillation patients with oral anticoagulants

Abstract

Abstract Background There were several limitations to the original HAS‐BLED (oHAS‐BLED) score in patients with atrial fibrillation (AF). This trial studied the revised HAS‐BLED (rHAS‐BLED) score for predicting bleeding events in anticoagulated AF patients. Methods This study retrospectively recruited anticoagulated AF patients in the Central Chest Institute of Thailand between 2014 and 2021. The rHAS‐BLED score was oHAS‐BLED using the estimated glomerular filtration rate of <60 ml/min/1.73 m2 for abnormal renal function, SAMe‐TT2R2 score of ≥3 for labile INR, and adding clinically relevant nonmajor bleeding (CRNMB) into bleeding history. The outcome was major bleeding (MB) and/or CRNMB at 1‐year follow‐up visit. The outcome between both groups was compared by using the chi‐square test or Fisher's exact test. Receiver‐operating characteristics curve was used to analyze the discrimination performances of both scores and the results were illustrated by using c‐statistics. Results A total of 256 anticoagulated AF patients were enrolled. The average age was 73.6 ± 10.1 years. The average oHAS‐BLED and rHAS‐BLED scores were 1.7 ± 0.9 and 2.6 ± 1.2, respectively. Twenty patients in rHAS‐BLED ≥3 (15.9%) and 9 patients in rHAS‐BLED <3 (6.9%) experienced MB and/or CRNMB. The rHAS‐BLED score of ≥3 increased the bleeding risk with statistical significance (OR 2.54, 95% CI 1.11–5.81, p = .04). The discriminative performance of the rHAS‐BLED score was illustrated with c‐statistics of 0.61 (95% CI 0.50–0.71). Conclusions The rHAS‐BLED score could predict bleeding events in anticoagulated AF patients. However, a larger study is needed to confirm these results in the future.

Keywords

• atrial fibrillation
• bleeding prediction model
• oral anticoagulants
• revised HAS‐BLED
• SAMe‐TT2R2