Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort

J B Olesen; G Y H Lip; P R Hansen; J Lindhardsen; O Ahlehoff; C Andersson; P Weeke; M L Hansen; G H Gislason; C Torp-Pedersen

doi:10.1111/j.1538-7836.2011.04378.x

Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort

J B Olesen, G Y H Lip, P R Hansen, J Lindhardsen, O Ahlehoff, C Andersson, P Weeke, M L Hansen, G H Gislason, C Torp-Pedersen

154 Citations (Scopus)

Abstract

Background: Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) is a double-edged sword, because it decreases the risk of stroke at the cost of an increased risk of bleeding. We compared the performance of a new bleeding prediction scheme, HAS-BLED, with an older bleeding prediction scheme, HEMORR ₂HAGES, in a cohort of 'real-world' AF patients. Methods: By individual-level-linkage of nationwide registers, we identified all patients (n=118584) discharged with non-valvular AF in Denmark during the period 1997-2006, with and without OAC. Major bleeding rates during 1year of follow-up were determined, and the predictive capabilities of the two schemes were compared by c-statistics. The risk of bleeding associated with individual risk factors composing HAS-BLED was estimated using Cox proportional-hazard analyses. Results: Of AF patients receiving OAC (n=44771), 34.8% and 47.3% were categorized as 'low bleeding risk' by HAS-BLED and HEMORR ₂HAGES, respectively, and the bleeding rates per 100 person-years were 2.66 (95% confidence interval [CI], 2.40-2.94) and 3.06 (2.83-3.32), respectively. C-statistics for the two schemes were 0.795 (0.759-0.829) and 0.771 (0.733-0.806), respectively. The risk factors composing HAS-BLED were associated with varying risks, with a history of bleeding (hazard ratio [HR] 2.98; 95% CI 2.68-3.31) and being elderly (HR 1.93; 95% CI 1.71-2.18) being associated with the highest risks. Comparable results were found in AF patients not receiving OAC (n=77813). Conclusions: In an unselected nationwide cohort of hospitalized patients with atrial fibrillation, the HAS-BLED score performs similarly to HEMORR ₂HAGES in predicting bleeding risk but HAS-BLED is much simpler and easier to use in everyday clinical practise.

Original language	English
Journal	Journal of Thrombosis and Haemostasis
Volume	9
Issue number	8
Pages (from-to)	1460-7
Number of pages	8
ISSN	1538-7933
DOIs	https://doi.org/10.1111/j.1538-7836.2011.04378.x https://doi.org/10.1111/j.1538-7836.2011.04378.x
Publication status	Published - 1 Aug 2011

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Olesen, J. B., Lip, G. Y. H., Hansen, P. R., Lindhardsen, J., Ahlehoff, O., Andersson, C., Weeke, P., Hansen, M. L., Gislason, G. H., & Torp-Pedersen, C. (2011). Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort. Journal of Thrombosis and Haemostasis, 9(8), 1460-7. https://doi.org/10.1111/j.1538-7836.2011.04378.x, https://doi.org/10.1111/j.1538-7836.2011.04378.x

Olesen, JB, Lip, GYH, Hansen, PR, Lindhardsen, J, Ahlehoff, O, Andersson, C, Weeke, P, Hansen, ML, Gislason, GH & Torp-Pedersen, C 2011, 'Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort', Journal of Thrombosis and Haemostasis, vol. 9, no. 8, pp. 1460-7. https://doi.org/10.1111/j.1538-7836.2011.04378.x, https://doi.org/10.1111/j.1538-7836.2011.04378.x

Olesen JB, Lip GYH, Hansen PR, Lindhardsen J, Ahlehoff O, Andersson C et al. Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort. Journal of Thrombosis and Haemostasis. 2011 Aug 1;9(8):1460-7. doi: 10.1111/j.1538-7836.2011.04378.x, http://dx.doi.org/10.1111/j.1538-7836.2011.04378.x

@article{2f69d1c6b9c543c3b04e166327244ca7,

title = "Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort",

abstract = "Background: Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) is a double-edged sword, because it decreases the risk of stroke at the cost of an increased risk of bleeding. We compared the performance of a new bleeding prediction scheme, HAS-BLED, with an older bleeding prediction scheme, HEMORR 2HAGES, in a cohort of 'real-world' AF patients. Methods: By individual-level-linkage of nationwide registers, we identified all patients (n=118584) discharged with non-valvular AF in Denmark during the period 1997-2006, with and without OAC. Major bleeding rates during 1year of follow-up were determined, and the predictive capabilities of the two schemes were compared by c-statistics. The risk of bleeding associated with individual risk factors composing HAS-BLED was estimated using Cox proportional-hazard analyses. Results: Of AF patients receiving OAC (n=44771), 34.8% and 47.3% were categorized as 'low bleeding risk' by HAS-BLED and HEMORR 2HAGES, respectively, and the bleeding rates per 100 person-years were 2.66 (95% confidence interval [CI], 2.40-2.94) and 3.06 (2.83-3.32), respectively. C-statistics for the two schemes were 0.795 (0.759-0.829) and 0.771 (0.733-0.806), respectively. The risk factors composing HAS-BLED were associated with varying risks, with a history of bleeding (hazard ratio [HR] 2.98; 95% CI 2.68-3.31) and being elderly (HR 1.93; 95% CI 1.71-2.18) being associated with the highest risks. Comparable results were found in AF patients not receiving OAC (n=77813). Conclusions: In an unselected nationwide cohort of hospitalized patients with atrial fibrillation, the HAS-BLED score performs similarly to HEMORR 2HAGES in predicting bleeding risk but HAS-BLED is much simpler and easier to use in everyday clinical practise.",

author = "Olesen, {J B} and Lip, {G Y H} and Hansen, {P R} and J Lindhardsen and O Ahlehoff and C Andersson and P Weeke and Hansen, {M L} and Gislason, {G H} and C Torp-Pedersen",

note = "{\textcopyright} 2011 International Society on Thrombosis and Haemostasis.",

year = "2011",

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doi = "10.1111/j.1538-7836.2011.04378.x",

language = "English",

volume = "9",

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TY - JOUR

T1 - Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort

AU - Olesen, J B

AU - Lip, G Y H

AU - Hansen, P R

AU - Lindhardsen, J

AU - Ahlehoff, O

AU - Andersson, C

AU - Weeke, P

AU - Hansen, M L

AU - Gislason, G H

AU - Torp-Pedersen, C

PY - 2011/8/1

Y1 - 2011/8/1

N2 - Background: Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) is a double-edged sword, because it decreases the risk of stroke at the cost of an increased risk of bleeding. We compared the performance of a new bleeding prediction scheme, HAS-BLED, with an older bleeding prediction scheme, HEMORR 2HAGES, in a cohort of 'real-world' AF patients. Methods: By individual-level-linkage of nationwide registers, we identified all patients (n=118584) discharged with non-valvular AF in Denmark during the period 1997-2006, with and without OAC. Major bleeding rates during 1year of follow-up were determined, and the predictive capabilities of the two schemes were compared by c-statistics. The risk of bleeding associated with individual risk factors composing HAS-BLED was estimated using Cox proportional-hazard analyses. Results: Of AF patients receiving OAC (n=44771), 34.8% and 47.3% were categorized as 'low bleeding risk' by HAS-BLED and HEMORR 2HAGES, respectively, and the bleeding rates per 100 person-years were 2.66 (95% confidence interval [CI], 2.40-2.94) and 3.06 (2.83-3.32), respectively. C-statistics for the two schemes were 0.795 (0.759-0.829) and 0.771 (0.733-0.806), respectively. The risk factors composing HAS-BLED were associated with varying risks, with a history of bleeding (hazard ratio [HR] 2.98; 95% CI 2.68-3.31) and being elderly (HR 1.93; 95% CI 1.71-2.18) being associated with the highest risks. Comparable results were found in AF patients not receiving OAC (n=77813). Conclusions: In an unselected nationwide cohort of hospitalized patients with atrial fibrillation, the HAS-BLED score performs similarly to HEMORR 2HAGES in predicting bleeding risk but HAS-BLED is much simpler and easier to use in everyday clinical practise.

AB - Background: Oral anticoagulation (OAC) in patients with atrial fibrillation (AF) is a double-edged sword, because it decreases the risk of stroke at the cost of an increased risk of bleeding. We compared the performance of a new bleeding prediction scheme, HAS-BLED, with an older bleeding prediction scheme, HEMORR 2HAGES, in a cohort of 'real-world' AF patients. Methods: By individual-level-linkage of nationwide registers, we identified all patients (n=118584) discharged with non-valvular AF in Denmark during the period 1997-2006, with and without OAC. Major bleeding rates during 1year of follow-up were determined, and the predictive capabilities of the two schemes were compared by c-statistics. The risk of bleeding associated with individual risk factors composing HAS-BLED was estimated using Cox proportional-hazard analyses. Results: Of AF patients receiving OAC (n=44771), 34.8% and 47.3% were categorized as 'low bleeding risk' by HAS-BLED and HEMORR 2HAGES, respectively, and the bleeding rates per 100 person-years were 2.66 (95% confidence interval [CI], 2.40-2.94) and 3.06 (2.83-3.32), respectively. C-statistics for the two schemes were 0.795 (0.759-0.829) and 0.771 (0.733-0.806), respectively. The risk factors composing HAS-BLED were associated with varying risks, with a history of bleeding (hazard ratio [HR] 2.98; 95% CI 2.68-3.31) and being elderly (HR 1.93; 95% CI 1.71-2.18) being associated with the highest risks. Comparable results were found in AF patients not receiving OAC (n=77813). Conclusions: In an unselected nationwide cohort of hospitalized patients with atrial fibrillation, the HAS-BLED score performs similarly to HEMORR 2HAGES in predicting bleeding risk but HAS-BLED is much simpler and easier to use in everyday clinical practise.

U2 - 10.1111/j.1538-7836.2011.04378.x

DO - 10.1111/j.1538-7836.2011.04378.x

M3 - Journal article

C2 - 21624047

SN - 1538-7933

VL - 9

SP - 1460

EP - 1467

JO - Journal of Thrombosis and Haemostasis

JF - Journal of Thrombosis and Haemostasis

IS - 8

ER -

Bleeding risk in 'real world' patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort

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