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April 23, 2015PLoS ONEOpen Access

The HAS-BLED Score Identifies Patients with Acute Venous Thromboembolism at High Risk of Major Bleeding Complications during the First Six Months of Anticoagulant Treatment

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Key result

A HAS-BLED score of ≥3 points identified patients with acute venous thromboembolism at an 8.7-fold increased risk of major bleeding complications during the first 6 months of VKA treatment.

Why the study?

Does a HAS-BLED score ≥ 3 identify patients at high risk of major bleeding during vitamin K-antagonist treatment for acute venous thromboembolism?

Population

537 patients with acute venous thromboembolism starting vitamin K-antagonist treatment between 2006-2007

Comparison

High HAS-BLED score (≥ 3 points) vs Non-high HAS-BLED score (< 3 points)

Design

Cohort

Follow-up

180 days

Authors

JKJudith KooimanNHNadja van HagenASAntonio Iglesias del Sol

Discussion

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Member takes

Overview

HAS-BLED ≥3 identifies higher major bleed risk in acute VTE on VKA; supports extension to this population but leaves validation open.

Study Design

Type

Cohort (n=537)

Multicenter

Yes

Structured PICO

Does a HAS-BLED score ≥ 3 identify patients at high risk of major bleeding during vitamin K-antagonist treatment for acute venous thromboembolism?

P
Population
537 patients with acute venous thromboembolism starting vitamin K-antagonist treatment, followed for up to 180 days to assess major bleeding risk.
E
Exposure
High HAS-BLED score (≥ 3 points)
C
Comparator
Non-high HAS-BLED score (< 3 points)
O
Outcome
Occurrence of major bleeds during the first 180 days of follow-upsafety

Main Result

Hazard Ratio: 8.7 (95% CI 2.7–28.4)

Absolute Event Rate: 9.6% vs 1.3%

p-value: p=<0.0001

The HAS-BLED score, originally designed for atrial fibrillation, effectively identifies acute VTE patients at high risk for major bleeding during the first 6 months of vitamin K-antagonist therapy.

Limitations

  • Retrospective design with missing information on some HAS-BLED items, most frequently alcohol use.
  • Potential for missed major bleeding events due to reliance on medical records.
  • Limited number of major bleeding events (11 events) in the cohort.
  • Exclusion of 163 patients not treated at designated hospitals.
  • Low sensitivity (54.6%) and positive predictive value (8.2%) for the HAS-BLED ≥3 cut-off.

Cite This Study

Kooiman et al. (2015) conducted a cohort in Acute venous thromboembolism (VTE) (n=537). HAS-BLED score ≥ 3 (high risk) vs. HAS-BLED score < 3 (non-high risk) was evaluated on Occurrence of major bleeding events (HR 8.7, 95% CI 2.7-28.4, p=<0.0001). A HAS-BLED score of ≥3 points identified patients with acute venous thromboembolism at an 8.7-fold increased risk of major bleeding complications during the first 6 months of VKA treatment.

synapsesocial.com/papers/6a6ae3639c58b04430f2c29dhttps://doi.org/10.1371/journal.pone.0122520
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