Key result
The ABC-bleeding risk score demonstrated comparable overall predictive performance to the modified HAS-BLED score (C-index 0.67 vs 0.63) but effectively identified high-risk patients who had a significantly increased risk of major bleeding (HR 4.92 vs low-risk).
Why the study?
To evaluate the performance of the ABC-bleeding risk score in estimating major bleeding risk in Chinese patients with AF on OAC therapy in real-world practice.
Does the ABC-bleeding risk score improve major bleeding risk prediction compared to the modified HAS-BLED score in Chinese patients with atrial fibrillation on oral anticoagulation?
Cohort (n=2,892)
Yes
Does the ABC-bleeding risk score improve major bleeding risk prediction compared to the modified HAS-BLED score in Chinese patients with atrial fibrillation on oral anticoagulation?
Hazard Ratio: 4.92 (95% CI 2.34–10.3)
Absolute Event Rate: 1.49% vs 0.31%
p-value: p=<0.001
The ABC-bleeding risk score provides comparable overall predictive value to the modified HAS-BLED score for major bleeding in Chinese AF patients on OAC, but offers better discrimination for identifying high-risk patients.
May aid high-risk stratification in Chinese AF on OAC; leaves open prospective validation versus HAS-BLED.
Objective To evaluate performance of the ABC (Age, Biomarkers, Clinical history)-bleeding risk score in estimating major bleeding risk in Chinese patients with atrial fibrillation (AF) on oral anticoagulation (OAC) therapy in real-world practice. Methods Data were collected from the Chinese Atrial Fibrillation Registry study (CAFR). Patients were stratified into low-, medium-, and high-risk groups based on ABC-bleeding risk score with 1-year major bleeding risk (<1%, 1–2%, and > 2%) and modified HAS-BLED score (≤1, 2, and > 2 points). Cox proportional-hazards (Cox-PH) models were used to determine the association of major bleeding incidence with bleeding scores. Harrell’s C-index of the two scores were compared. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) at 1 year were employed to evaluate the reclassification capacity. The calibration curve was plotted to compare the predicted major bleeding risk using ABC-bleeding risk score with the observed annualized event rate. The decision analysis curves (DCA) were performed to show the clinical utilization of two scores in identifying major bleeding events. Results The study included 2,892 AF patients on OAC therapy. After the follow-up of 3.0 years, 48 patients had major bleeding events; the incidence of a bleeding event in the low-, medium-, and high-risk groups according to ABC-bleeding risk score was 0.31% (reference group, HR = 1.00),0.51% (HR = 1.83, 95%CI: 0.91–3.69, P = 0.09), and 1.49% (HR = 4.92, 95%CI: 2.34–10.30, P < 0.001), respectively. Major bleeding incidence had an independent association with growth differentiation factor 15 (GDF-15) level (HR = 2.16, 95%CI: 1.27–3.68, P = 0.005) after adjusting components of the HAS-BLED score and cTnT-hs level. The ABC-bleeding score showed a Harrell’s C-index of 0.67 (95%CI: 0.60–0.75) in estimating major bleeding risk, which was non-significant compared to the modified HAS-BLED score (0.67 vs. 0.63; P = 0.38). NRI and IDI also revealed comparable reclassification capacity of ABC-bleeding risk score compared with HAS-BLED score (14.6%, 95%CI: −10.2%, 39.4%, P = 0.25; 0.2%, 95%CI −0.1 to 0.9%, P = 0.64). Cross-tabulation of the two scores showed that the ABC-bleeding score outperformed the HAS-BLED score in identifying patients with a high risk of major bleeding. The calibration curve showed that the ABC-bleeding risk score overestimated the observed major bleeding risk. DCA did not show any difference in net benefit when using either of the scores. Conclusion This study verified the value of the ABC-bleeding risk score in assessing major bleeding risk in Chinese patients with AF on OAC therapy in real-world practice. Despite the overestimation of major bleeding risk, ABC-bleeding score performed better in stratifying patients with a high risk than the modified HAS-BLED score. Combining the two scores could be a clinically practical strategy for precisely stratifying AF patients, especially those at a high risk of major bleeding, and further supporting the optimization of OAC treatment.
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Wang et al. (2022) conducted a cohort in Atrial fibrillation on oral anticoagulation therapy (n=2,892). High ABC-bleeding risk score vs. Low ABC-bleeding risk score was evaluated on Major bleeding events (HR 4.92, 95% CI 2.34-10.30, p=<0.001). The ABC-bleeding risk score demonstrated comparable overall predictive performance to the modified HAS-BLED score (C-index 0.67 vs 0.63) but effectively identified high-risk patients who had a significantly increased risk of major bleeding (HR 4.92 vs low-risk).
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