title: HAS-BLED and CHA₂DS₂-VASc scores as predictors of bleeding and thrombotic risk after continuous-flow ventricular assist device implantation.
abstract: BACKGROUND
  HAS-BLED and CHA₂DS₂-VASc scores predict bleeding in patients on anticoagulation and thromboembolic (TE) risk in patients with atrial fibrillation, respectively. We hypothesized that these scores would be predictive of bleeding and TE complications following continuous-flow ventricular assist device (CF-VAD) implantation.
  
  
  RESULTS
  Baseline HAS-BLED and CHA2DS2-VASc scores were retrospectively determined for 173 consecutive patients who underwent HeartMate II CF-VAD implantation at a single center from 2005 to 2011. Forty-three patients had bleeding (24.9%) and 22 had TE (12.7%) events over a 290 patient-year follow-up period. The mean ± SD HAS-BLED scores were 2.7 ± 1.0 and 1.9 ± 1.1 (P < .0001) in patients with and without bleeding, respectively. The CHA₂DS₂-VASc scores were 3.6 ± 1.4 and 2.9 ± 1.5 (P = .03) in patients with and without TE events, respectively. A HAS-BLED score of ≥ 3 was associated with a significantly higher risk of bleeding events compared with a score of <3 (42% vs 15%, respectively; hazard ratio [HR] 3.40, 95% confidence interval [CI] 1.82-6.32; P < .001). A CHA₂DS₂-VASc score of ≥ 3 was associated with a higher risk of TE events compared with a score of <3 (18% vs 4%, respectively; HR 4.02, 95% CI 1.19-13.6; P = .025).
  
  
  CONCLUSIONS
  Baseline HAS-BLED and CHA₂DS₂-VASc scores of ≥ 3 conferred significantly higher risks of bleeding and TE, respectively, following HeartMate II implantation.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota. Electronic address: ryankoene@gmail.com.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Koene
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sithu
authors.initials: S
authors.lastname: Win
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors.forename: Niyada
authors.initials: N
authors.lastname: Naksuk
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Sirtaz N
authors.initials: SN
authors.lastname: Adatya
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Rosenbaum
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Eckman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D019919:Prosthesis Implantation / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013927:Thrombosis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
keywords: Ventricular assist devices; clotting; heart failure; hemorrhage; risk factors