Key result
Risk scores predict DOAC-related GIB with up to ~0.71 AUROC, performing better without concomitant antiplatelets.
Why the study?
The risk of gastrointestinal bleeding remains a concern with direct oral anticoagulants, prompting evaluation of four risk-scoring models according to concomitant antiplatelet therapy.
How do HAS-BLED, ATRIA, VTE-BLEED, and ORBIT risk scores perform in predicting gastrointestinal bleeding in DOAC users with and without concomitant antiplatelet therapy?
Cohort (n=4,494)
Yes
How do HAS-BLED, ATRIA, VTE-BLEED, and ORBIT risk scores perform in predicting gastrointestinal bleeding in DOAC users with and without concomitant antiplatelet therapy?
Current bleeding risk scores perform better in DOAC users who are not on concomitant antiplatelet therapy, suggesting future models should incorporate antiplatelet use to improve diagnostic accuracy.
Modest HAS-BLED discrimination cautions against sole reliance for GIB prediction in DOAC users; leaves open need for refined models.
BACKGROUND AND AIM: The risk of gastrointestinal bleeding (GIB) remains a concern with the use of direct oral anticoagulants (DOAC). We evaluated the efficacy of four risk-scoring models (HAS-BLED, ATRIA, VTE-BLEED, and ORBIT) in predicting GIB according to the concomitant use of antiplatelet therapy in DOAC users. METHODS: Patients prescribed DOAC between December 2014 and October 2020 were enrolled in two university-affiliated hospitals. The performance of the four models was compared based on the concomitant use of antiplatelet therapy. The primary outcomes were likelihood ratios and the area under the receiver operating characteristic (AUROC) curve to predict GIB. RESULTS: A total of 4494 patients were included in the study. The AUROC values for the entire cohort were 0.643 (95% CI: 0.601-0.686) for HAS-BLED, 0.693 (95% CI: 0.649-0.737) for ATRIA, 0.708 (95% CI: 0.665-0.750) for VTE-BLEED, and 0.709 (95% CI: 0.667-0.751) for ORBIT. The AUROC for all scoring models increased in patients without antiplatelet therapy compared to the entire cohort and patients with antiplatelet therapy. The specificity and diagnostic accuracy for all scoring models increased in patients without antiplatelet therapy compared to patients with antiplatelet. CONCLUSIONS: Our results confirmed that current risk-scoring models for predicting GIB perform better in patients without antiplatelet therapy than in those on concomitant antiplatelet therapy. This suggests that future risk prediction models should consider the concomitant use of antiplatelet therapy for diagnostic accuracy.
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Kim et al. (2024) conducted a cohort in Gastrointestinal bleeding in DOAC users (n=4,494). Risk-scoring models (HAS-BLED, ATRIA, VTE-BLEED, ORBIT) was evaluated on Likelihood ratios and the area under the receiver operating characteristic (AUROC) curve to predict gastrointestinal bleeding (AUROC 0.709 for ORBIT, 95% CI 0.667-0.751). Risk-scoring models predicted gastrointestinal bleeding in DOAC users with AUROCs from 0.643 (HAS-BLED) to 0.709 (ORBIT), performing better in patients without concomitant antiplatelet therapy.
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