Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 28;20(9):684-692.
doi: 10.26599/1671-5411.2023.09.002.

Predictive value of bleeding risk scores in elderly patients with atrial fibrillation and oral anticoagulation

Pablo Domínguez-Erquicia  1   2 , Sergio Raposeiras-Roubín  1   2 , Emad Abu-Assi  1   2 , Andrea Lizancos-Castro  1 , Jose A Parada-Barcia  1 , André González-García  1 , Ana Ledo-Piñeiro  1 , Vanesa Noriega-Caro  1 , Carla Iglesias-Otero  1 , Andrés Íñiguez-Romo  1   2
Affiliations

Predictive value of bleeding risk scores in elderly patients with atrial fibrillation and oral anticoagulation

Pablo Domínguez-Erquicia et al. J Geriatr Cardiol. .

Abstract

Background: The predictive value of bleeding risk scores for atrial fibrillation in older patients is not as well known. The goal of this study was to evaluate the predictive value of HASBLED, ORBIT and ATRIA for major bleeding (MB) and intracranial hemorrhage (ICH) in patients ≥ 75 years with atrial fibrillation and oral anticoagulation (OAC).

Methods: A retrospective unicenter study including patients ≥ 75 years with atrial fibrillation (AF) and OAC. A total of 7613 patients ≥ 75 years with AF and OAC included between 2014 and 2018 (registry: NCT04364516). We analyzed the discriminative value of HASBLED, ATRIA and ORBIT scores for bleeding endpoints (major bleeding as primary endpoint and intracerebral hemorrhage as secondary). Cox regression was used to predict major bleeding with each scale and also for searching other variables potentially predictor of major bleeding. Model discrimination was assessed using Harrell's C-statistic. Calibration was assessed with goodness-of-fit test proposed by Gronnesby and Borgan.

Results: During a mean follow up of 4.0 years (IQR: 2.4-5.7 years), 729 patients developed MB (2.61 per 100 patients/year) and 243 patients developed ICH (0.85 per 100 patients/year). Three scores showed a low discrimination for major bleeding, being ORBIT the best (HASBLED C statistic = 0.557; ATRIA C statistic = 0.568; ORBIT C statistic = 0.595) and also a low discrimination for ICH (HASBLED C statistic = 0.509; ATRIA C statistic = 0.522; ORBIT C statistic = 0.526). Among the variables that are part of the scores and other baseline characteristics, after multivariable adjustment only sex (male), dementia, prior admission for bleeding, anemia and liver disease were found as a predictors of MB.

Conclusions: In older patients under oral anticoagulation with atrial fibrillation, the risk scores HASBLED, ATRIA and ORBIT showed a weak discrimination for major bleeding and intracranial hemorrhage. Therefore, other better alternatives should be evaluated for this purpose.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Receiver Operating Characteristic (ROC) curves for each score.
Figure 2
Figure 2
Percentage of patients and percentage of MB events (with respect to the total MB) according to the risk group.
See this image and copyright information in PMC

References

    1. Hindricks G, Potpara T, Dagres N, et al. ESC Scientific Document Group 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J 2020; ehaa612.

    1. Fumagalli S, Said SAM, Laroche C, et al Age-related differences in presentation, treatment, and outcome of patients with atrial fibrillation in Europe: The EORP-AF General Pilot Registry (EURObservational Research Programme-Atrial Fibrillation) JACC Clin Electrophysiol. 2015;1:326–334. doi: 10.1016/j.jacep.2015.02.019. - DOI - PubMed
    1. Pisters R, Lane DA, Nieuwlaat R, et al A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138:1093–100. doi: 10.1378/chest.10-0134. - DOI - PubMed
    1. O'Brien EC, Simon DN, Thomas LE, et al The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation. Eur Heart J. 2015;36:3258–3264. - PMC - PubMed
    1. Fang MC, Go AS, Chang Y, et al A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study. J Am Coll Cardiol. 2011;58:395–401. doi: 10.1016/j.jacc.2011.03.031. - DOI - PMC - PubMed

LinkOut - more resources