title: Performance of bleeding risk-prediction scores in patients with atrial fibrillation undergoing percutaneous coronary intervention.
abstract: The hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, and drugs/alcohol (HAS-BLED); anticoagulation and risk factors in atrial fibrillation (ATRIA); modified Outpatient Bleeding Risk Index (mOBRI); and reduction of atherothrombosis for continued health (REACH) schemes are validated bleeding risk-prediction tools, but their predictive performance in patients with AF receiving multiple antithrombotic drugs after percutaneous coronary intervention (PCI) is unknown. We sought to compare the predictive performance of bleeding risk-estimation tools in a cohort of patients with atrial fibrillation (AF) undergoing PCI. Management of patients with AF undergoing coronary artery stenting is a multicenter European prospective registry enrolling patients with AF undergoing PCI. We calculated HAS-BLED, ATRIA, mOBRI, and REACH bleeding risk-prediction scores and assessed the rate of bleeding complications as defined by Bleeding Academic Research Consortium at 12 months follow-up in 929 consecutive patients undergoing PCI. Increasing age, femoral access site, and previous peptic ulcer were independent determinants of bleeding. Low bleeding risk scores as determined by HAS-BLED 0 to 2, ATRIA 0 to 3, mOBRI 0, and REACH 0 to 10 were detected in 23.7%, 73.0%, 7.8%, and 5.7% of patients of the cohort, respectively. No significant differences were detected in the rates of any bleeding or major bleeding events for low versus intermediate/high scores with each risk-prediction tool. In conclusion, the performance of ATRIA, HAS-BLED, mOBRI, and REACH scores in predicting bleeding complications in this high-risk patient subset was useless.
authors.affiliation: Heart Center, Turku University Hospital and University of Turku, Turku, Finland. Electronic address: tuoski@utu.fi.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Kiviniemi
authors.affiliation: Hemostasis laboratory, Finnish Red Cross Blood Service, Helsinki, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Puurunen
authors.affiliation: Medical Faculty, Martin Luther University Halle-Wittenberg and Paracelsus-Harz-Clinic Bad Suderode, Halle-Wittenberg, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Schlitt
authors.affiliation: Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rubboli
authors.affiliation: Heart Center, Satakunta Central Hospital, Pori, Finland.
authors.forename: Pasi
authors.initials: P
authors.lastname: Karjalainen
authors.affiliation: Heart Center, Tampere University Hospital, Tampere, Finland.
authors.forename: Saila
authors.initials: S
authors.lastname: Vikman
authors.affiliation: Department of Medicine, Oulu University Hospital, Oulu, Finland.
authors.forename: Matti
authors.initials: M
authors.lastname: Niemelä
authors.affiliation: Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
authors.forename: Heli
authors.initials: H
authors.lastname: Lahtela
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
authors.forename: K E Juhani
authors.initials: KE
authors.lastname: Airaksinen
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D015331:Cohort Studies; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants