title: Performance of the HAS-BLED high bleeding-risk category, compared to ATRIA and HEMORR2HAGES in patients with atrial fibrillation: a systematic review and meta-analysis.
abstract: BACKGROUND
  Atrial fibrillation (AF) patients' major bleeding risk should be evaluated through risk scores such as HAS-BLED, HEMORR2HAGES or ATRIA. These scores were validated in independent studies with different methods. Therefore, we aimed to review and estimate the value added by ATRIA and HEMORR2HAGES compared to HAS-BLED.
  
  
  METHODS
  Medline and Cochrane Library (July 2013) were searched, as well as reviews and references of obtained articles. We looked for studies reporting data for diagnostic accuracy of HAS-BLED with any of HEMORR2HAGES or ATRIA scores, concerning Major Bleeding events. We determined the sensitivity, specificity, and diagnostic odds ratio (DOR) of ATRIA and HEMORR2HAGES compared to HAS-BLED within the same studies. Random effects meta-analysis was performed in order to derive diagnostic accuracy estimates. Heterogeneity was assessed through I (2) test.
  
  
  RESULTS
  Six studies fulfilled inclusion criteria. Five studies evaluated simultaneously HAS-BLED and HEMORR2HAGES. Sensitivity, specificity, and DOR were respectively 0.53 (0.52-0.54), 0.65 (0.65-0.65) and 2.11 (1.91-2.35) for HAS-BLED, and 0.27 (0.26-0.27), 0.89 (0.89-0.89) and 2.90 (2.77-3.04) for HEMORR2HAGES. Four studies compared HAS-BLED with ATRIA. Sensitivity, specificity, and DOR were respectively 0.41 (0.35-0.48), 0.78 (0.76-0.79) and 2.22 (1.08-4.55) for HAS-BLED, and 0.23 (0.17-0.29), 0.91 (0.90-0.91) and 1.98 (1.29-3.03) for ATRIA.
  
  
  CONCLUSIONS
  The 'high-risk' categories of the evaluated major bleeding-risk scores are not sensitive. HAS-BLED, due to its sensitivity (compared to other scores) and ease to apply, is recommended for the assessment of AF patients' major bleeding risk.
authors.affiliation: Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal, dgcaldeira@hotmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Caldeira
authors.forename: João
authors.initials: J
authors.lastname: Costa
authors.forename: Ricardo M
authors.initials: RM
authors.lastname: Fernandes
authors.forename: Fausto J
authors.initials: FJ
authors.lastname: Pinto
authors.forename: Joaquim J
authors.initials: JJ
authors.lastname: Ferreira
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology; D003661:Decision Support Techniques; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity