Why the study?
Multiple bleeding risk scores are used and have been validated in anticoagulated patients with AF, prompting a comparison of major bleeding across risk categories between HAS-BLED and HEMORR2HAGES, ATRIA, or ORBIT scores.
Does the HAS-BLED score better predict major bleeding risk compared to HEMORR2HAGES, ATRIA, or ORBIT scores in anticoagulated patients with atrial fibrillation?
Does the HAS-BLED score better predict major bleeding risk compared to HEMORR2HAGES, ATRIA, or ORBIT scores in anticoagulated patients with atrial fibrillation?
The HAS-BLED score distributes more major bleeding events into 'low' or 'moderate' risk categories compared to HEMORR2HAGES, ATRIA, or ORBIT scores in anticoagulated AF patients.
Supports HAS-BLED ≥3 for identifying high major bleeding risk in anticoagulated AF; extends comparative validation versus HEMORR2HAGES, ATRIA, and ORBIT.
BACKGROUND: The HAS-BLED, HEMORR2HAGES, ATRIA, and ORBIT scores are used to predict bleeding risk in anticoagulated patients with atrial fibrillation (AF). Recently, these scores have been validated in various studies. Therefore, we aimed to compare the occurrence of major bleeding across different risk categories between HAS-BLED and any of HEMORR2HAGES, ATRIA, or ORBIT scores. METHODS: A systemic literature search of PubMed and Embase databases was conducted to screen the relevant studies. We calculated and pooled the odds ratios (ORs) and 95% confidence intervals (CIs) for a comparative analysis of the occurrence of major bleeding. RESULTS: Nine studies fulfilled the inclusion criteria in this meta-analysis. Compared with HEMORR2HAGES, there were 87% and 39% reduced rates of major bleeding in the HAS-BLED "low-risk" and "moderate-risk" groups, respectively. Compared with ATRIA, there was an 89% decreased rate of major bleeding in the HAS-BLED "low-risk" group. Compared with ORBIT, there were 84% and 44% reduced rates of major bleeding in the HAS-BLED "low-risk" and "moderate-risk" groups, respectively. Patients with HAS-BLED scores ≥3 showed an approximately 3-fold greater risk of major bleeding compared with patients with scores <3 (OR=3.00, CI: 1.21-7.43). CONCLUSIONS: Compared with any of HEMORR2HAGES, ATRIA, or ORBIT scores, the HAS-BLED score distributed more major bleeding events into the "low" or "moderate" risk categories.
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Zeng et al. (2020) studied this question.
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