title: Scores to predict major bleeding risk during oral anticoagulation therapy: a prospective validation study.
abstract: BACKGROUND
  Clinical scores may help physicians to better assess the individual risk/benefit of oral anticoagulant therapy. We aimed to externally validate and compare the prognostic performance of 7 clinical prediction scores for major bleeding events during oral anticoagulation therapy.
  
  
  METHODS
  We followed 515 adult patients taking oral anticoagulants to measure the first major bleeding event over a 12-month follow-up period. The performance of each score to predict the risk of major bleeding and the physician's subjective assessment of bleeding risk were compared with the C statistic.
  
  
  RESULTS
  The cumulative incidence of a first major bleeding event during follow-up was 6.8% (35/515). According to the 7 scoring systems, the proportions of major bleeding ranged from 3.0% to 5.7% for low-risk, 6.7% to 9.9% for intermediate-risk, and 7.4% to 15.4% for high-risk patients. The overall predictive accuracy of the scores was poor, with the C statistic ranging from 0.54 to 0.61 and not significantly different from each other (P=.84). Only the Anticoagulation and Risk Factors in Atrial Fibrillation score performed slightly better than would be expected by chance (C statistic, 0.61; 95% confidence interval, 0.52-0.70). The performance of the scores was not statistically better than physicians' subjective risk assessments (C statistic, 0.55; P=.94).
  
  
  CONCLUSIONS
  The performance of 7 clinical scoring systems in predicting major bleeding events in patients receiving oral anticoagulation therapy was poor and not better than physicians' subjective assessments.
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120-1613, USA. jdonze@partners.org
authors.forename: Jacques
authors.initials: J
authors.lastname: Donzé
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rodondi
authors.forename: Gérard
authors.initials: G
authors.lastname: Waeber
authors.forename: Pierre
authors.initials: P
authors.lastname: Monney
authors.forename: Jacques
authors.initials: J
authors.lastname: Cornuz
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001777:Blood Coagulation; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
chemical_list: D000925:Anticoagulants