Guo Y, et al. - The study is performed to analyze bleeding risk assessment concentrated on modifiable risk factors only to validate the bleeding risk scores in atrial fibrillation. Relying on bleeding risk evaluation utilizing modifiable bleeding risk factors alone is an inferior strategy for predicting atrial fibrillation patients at high risk for major bleeding, intracranial haemorrhage or extracranial bleeding. Their observations re-affirm the Asian guideline proposals on utilizing the HAS-BLED score for bleeding risk evaluation in patients with atrial fibrillation.

Methods

• In a large hospital-based cohort of Chinese inpatients with atrial fibrillation, they compared the score based on the numbers of the modifiable bleeding risk factors suggested in the 2016 European guidelines (‘European risk score’), to other published bleeding risk scores that have been derived and validated in atrial fibrillation subjects (HEMORR2HAGES, HAS-BLED, ATRIA and ORBIT).

Results

• In this study, they observed European score had modest predictive ability for major bleeding (c- index 0.63, 95% CI 0.56-0.69) and intracranial haemorrhage (0.72, 0.65-0.79), but non-significantly (and poorly) predicted extracranial bleeding (0.55, 0.54-0.56, p=0.361).
• The HAS-BLED score was better than predict bleeding events compared to the European score, with the differences between c-indexes of 0.10-0.12 (Delong test, all P <0.05), net reclassification improvement (NRI) values of 13.0%-34.5% (all p<0.05), and integrated discrimination improvement (IDI) values of 0.7%-1.4% (all p<0.05).
• The European score had similar predictive value to other bleeding risk schemes (HEMORR2HAGES, ATRIA and ORBIT) for major bleeding and intracranial haemorrhage, as reflected by non-significant differences in c-indexes, NRI and IDI (all p >0.05).
• HEMORR2HAGES and ATRIA were better than the European score for predicting extracranial bleeding.
• Decision curve investigation clearly demonstrates that HAS-BLED had better net benefit of predicting major bleeding compared to the European score.