August 1, 2025SHILAP Revista de lepidopterología1 citationsOpen Access

Bleeding Risk Prediction in Non-Valvular Atrial Fibrillation: Comparing Risk Scores in Apixaban- and Rivaroxaban-Treated Patients

CAChristian Andrew AlmalbisUniversity Kebangsaan Malaysia Medical Centre ARAdyani Md RedzuanNational University of Malaysia SSShamin Mohd SaffianUniversity Kebangsaan Malaysia Medical Centre

Structured PICO

Do existing bleeding risk assessment tools accurately predict bleeding in NVAF patients treated with apixaban or rivaroxaban?

Population

Patients with non-valvular atrial fibrillation (NVAF) treated with apixaban or rivaroxaban

Intervention

Bleeding risk assessment tools (including HAGES, A4C, and HAS-BLED)

Outcome

Diagnostic accuracy of bleeding risk assessment tools (measured by AUROC)

Current bleeding risk scores, including HAS-BLED, demonstrate poor diagnostic accuracy in NVAF patients on apixaban or rivaroxaban, indicating a need for new, population-specific prediction tools.

Abstract

HAGES (0.66) showed sufficient accuracy. For apixaban users, A4C performed best (AUROC 0.64); HAS-BLED showed no diagnostic value (AUROC 0.42). Some tools showed good subgroup accuracy.ConclusionNone of the bleeding risk assessment tools achieved good overall diagnostic accuracy in NVAF patients treated with apixaban or rivaroxaban. Further studies are needed to validate existing tools and to develop a bleeding risk score with acceptable diagnostic accuracy for this patient population.

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