title: Comparison of HAS-BLED and HAS-BED Versus CHADS2and CHA2DS2VASC Stroke and Bleeding Scores in Patients With Atrial Fibrillation.
abstract: Anticoagulation is recommended in patients with atrial fibrillation (AF) for stroke prevention, and the bleeding risk associated suggests the need for a bleeding risk stratification. HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio (INR), elderly >65 years, drugs/alcohol concomitantly) score includes "labile INR" referred to quality of anticoagulation. However, in naïve patients, this item is not available. In addition, stroke and bleeding risk prediction scores shared several risk factors. The aims of our study were as follows: (1) to evaluate if the HAS-BLED score in its refined form excluding "labile INR" (HAS-BED [hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, elderly, drugs/alcohol]) is still associated with bleeding risk and (2) to evaluate the predictive ability for bleeding of both stroke and bleeding prediction models. We followed an inception cohort of 4,579 patients with AF enrolled in the Survey on anticoagulaTed pAtients RegisTer (NCT02219984). Major bleeds were recorded. During follow-up (7,014 patient-years), 115 patients experienced a major bleeding (MB; rate 1.6 × 100 patient-years). Patients at high risk were better identified by HAS-BLED and HAS-BED scores with respect to CHADS2(congestive heart failure, hypertension, age >75 years, diabetes, previous stroke or transient ischemic attack) and CHA2DS2VASc (congestive heart, failure, hypertension, age [>75 years], diabetes, stroke/transient ischemic attack, vascular disease, age [65 to 74 years], female gender). HAS-BLED has a slightly higher c value in comparison to CHADS2and CHA2DS2VASc. However, among naïve patients, the predictive ability for hemorrhage of HAS-BED score is overlapping with CHADS2and CHA2DS2VASc. In low stroke risk patients (CHA2DS2VASc = 0 to 1), only 6 patients are at high bleeding risk, and none of them experienced MB. In conclusion, in our prospective cohort of patients with AF, we found that HAS-BLED and HAS-BED scores identify patients at high bleeding risk. However, the predictive value for MB of HAS-BED used in naïve patients is similar to CHADS2or CHA2DS2VASc, suggesting that stroke stratification scores could be sufficient for tailoring treatment.
authors.affiliation: Thrombosis Centre, Oncology Department, AziendaOspedaliero-Universitaria Careggi, Florence, Italy. Electronic address: polida@aou-careggi.toscana.it.
authors.forename: Daniela
authors.initials: D
authors.lastname: Poli
authors.affiliation: Start Register Section, Arianna Anticoagulazione Foundation, Bologna, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Antonucci
authors.affiliation: Department of Cardiac Thoracic and Vascular Sciences, Thrombosis Centre, University of Padua, Padua, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Pengo
authors.affiliation: Haemostasis and Thrombosis Centre, Laboratory Department, Hospital of Cremona, Cremona, Italy.
authors.forename: Sophie
authors.initials: S
authors.lastname: Testa
authors.affiliation: Coordinator of the Survey on anticoagulaTed pAtients-RegisTr, Bologna, Italy.
authors.forename: Gualtiero
authors.initials: G
authors.lastname: Palareti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D055118:Medication Adherence; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants