The HAS-BLED score has better prediction accuracy for major bleeding than the CHADS2 or CHA2DS2-VASc scores In anticoagulated patients with atrial fibrillation ONLINE FIRST

JACC: September 1, 2013

Objectives  To test the hypothesis that a specific bleeding risk score, HAS-BLED was better at predicting major bleeding compared to CHADS2 and CHA2DS2-VASc in anticoagulated atrial fibrillation (AF) patients.

Background  The CHADS2 and CHA2DS2-VASc scores are well-validated stroke risk prediction scores for AF, but are also associated with increased bleeding and mortality.

Methods  We recruited 1370 consecutive AF patients (49% male; median age 76) on OAC from our out-patient anticoagulation clinic, all of whom were anticoagulated with acenocoumarol and had an INR between 2.0 and 3.0 during the preceding 6 months. During follow-up, major bleeding events were identified by the 2005 International Society on Thrombosis and Haemostasis (ISTH) criteria. Model performance was evaluated by calculating c-statistics, and the improvement in predictive accuracy was evaluated by calculating the net reclassification improvement(NRI) and integrated discrimination improvement(IDI). Read more