Assessing the Risk of Bleeding in Patients With Atrial Fibrillation

Management decisions for thromboprophylaxis in atrial fibrillation need to balance the risk of stroke against serious hemorrhage. The objective of the present analysis is to compare the Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/alcohol concomitantly (HAS-BLED) score against other older bleeding risk scores and the new Anticoagulation and Risk Factors in Atrial Fibrillation score in an atrial fibrillation cohort.

Methods and Results—Patients diagnosed with nonvalvular atrial fibrillation in a 4-hospital institution between 2000 and 2010 were identified. Independent risk factors of bleeding were investigated using Cox regression. The predictive value of several bleeding risk schema was assessed using the c-statistic and net reclassification improvement. Oral anticoagulation use was highest in moderate-risk patients (59.8%) but only slightly more than high-risk (50.1%) and low-risk (46.4%) patients.  Read more