title: Development of a contemporary bleeding risk model for elderly warfarin recipients.
abstract: OBJECTIVE
  Develop and validate a contemporary bleeding risk model to guide the clinical use of warfarin in the elderly atrial fibrillation (AF) population.
  
  
  METHODS
  Chart-abstracted data from the National Registry of Atrial Fibrillation was combined with Medicare part A claims to identify major bleeding events requiring hospitalization. Using a split-sample technique, candidate variables that provided statistically stable relationships with major bleeding events were selected for model development. Three risk categories were created and validated. The new model was compared to existing bleeding risk models using c-statistics and Kaplan-Meier curves.
  
  
  RESULTS
  Model development and validation was conducted on 26,345 AF patients who were > 65 years of age and had been discharged from the hospital while receiving warfarin therapy. The following eight variables were included in the final risk score model: age > or = 70 years; gender; remote bleeding; recent (ie, during index hospitalization) bleeding; alcohol/drug abuse; diabetes; anemia; and antiplatelet use. Bleeding rates were 0.9%, 2.0%, and 5.4%, respectively, for the groups with low, moderate, and high risk, compared to the bleeding rates for groups with moderate risk (1.5% and 1.0%) and high risk (1.8% and 2.5%) from other models.
  
  
  CONCLUSIONS
  Using a nationally derived data set, we developed a model based on contemporary practice standards for determining major bleeding risk among AF patients receiving warfarin therapy. The larger sample size afforded the opportunity to incorporate additional risk factors. In addition, since the majority of our population was > 65 years of age, we had greater ability to stratify risk among the elderly.
authors.affiliation: Department of Preventive Medicine & Public Health, University of Kansas Medical Center, Kansas City, KS 66160, USA. tshireman@kumc.edu
authors.forename: Theresa I
authors.initials: TI
authors.lastname: Shireman
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Mahnken
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Howard
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Kresowik
authors.forename: Qingjiang
authors.initials: Q
authors.lastname: Hou
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology; D015331:Cohort Studies; D003661:Decision Support Techniques; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000517:prevention & control; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin