Key result
GARFIELD-AF, HAS-BLED, and ORBIT scores predict major bleeding similarly in anticoagulated Asian AF patients.
Why the study?
Comparative data between the HAS-BLED, GARFIELD-AF, and ORBIT scores are limited in anticoagulated Asian patients with AF.
How do the HAS-BLED, GARFIELD-AF, and ORBIT bleeding risk scores compare in predicting major bleeding in Asian patients with atrial fibrillation on oral anticoagulants?
Cohort (n=2,568)
Yes
How do the HAS-BLED, GARFIELD-AF, and ORBIT bleeding risk scores compare in predicting major bleeding in Asian patients with atrial fibrillation on oral anticoagulants?
The HAS-BLED, GARFIELD-AF, and ORBIT scores demonstrated similar, modest predictive performance for major bleeding in Asian patients with AF on oral anticoagulants, with no clear advantage for the ORBIT score.
Modest C-statistics for major bleeding prediction in anticoagulated Asian AF patients; leaves open need for improved, validated risk tools.
AIMS: Comparative data between the HAS-BLED, GARFIELD-AF and ORBIT score are limited in anticoagulated Asian patients with atrial fibrillation (AF). We compared the performance of the 3 scores in a nationwide registry. METHODS: AF patients treated with oral anticoagulants in the COOL-AF registry were studied. We fitted the variables of the HAS-BLED, GARFIELD-AF and ORBIT score to major bleeding in Cox model. We explored a modified HAS-BLED by addition of sex and body weight. Discrimination, calibration, net reclassification index (NRI) and decision curve analysis were used to compare the performance of the 3 models. RESULTS: Of 3402 patients in the registry, 2568 patients who received oral anticoagulant at baseline were studied. Majority of patients (91.1%) received warfarin. The rate of major bleeding was 2.11 per 100 person-years. The C-statistics of the GARFIELD-AF, HAS-BLED, modified HAS-BLED and ORBIT score were 0.65 (95% confidence interval [CI] 0.63-0.67), 0.66 (95%CI 0.64-0.68), 0.69 (95%CI 0.67-0.71) and 0.64 (95%CI 0.62-0.66) respectively. There was good agreement between predicted and observed bleeding in the deciles of HAS-BLED and GARFIELD-AF scores, while the modified HAS-BLED score and ORBIT score overestimated the risk in the last decile. The modified HAS-BLED score had superior NRI than the HAS-BLED score (26.9%, 95%CI 9.7%-42.2%) and the ORBIT score (31.9%, 95%CI 9.0-53.6%). The NRI between the modified HAS-BLED and GARFIELD-AF score was similar. The net benefit curve of the 4 models were overlapping among different thresholds. CONCLUSIONS: The clinical utility for bleeding prediction of GARFIELD-AF, HAS-BLED, modified HAS-BLED and ORBIT scores were similar in anticoagulated Asian patients with AF participating in the COOL-AF registry. We found no advantage of the ORBIT over HAS-BLED score for bleeding risk prediction, even in direct oral anticoagulant users.
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Chichareon et al. (2023) conducted a cohort in Atrial fibrillation (n=2,568). Bleeding risk scores (HAS-BLED, GARFIELD-AF, ORBIT) was evaluated on Major bleeding. GARFIELD-AF, HAS-BLED, and ORBIT scores showed similar clinical utility for predicting major bleeding in anticoagulated Asian patients with atrial fibrillation (C-statistics 0.65, 0.66, and 0.64).
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