Key result
A novel model using previous bleeding and hemoglobin outperformed the HAS-BLED score in predicting BARC class ≥3 bleeding (c-statistic 0.704 vs 0.575, p=0.008).
Why the study?
The study evaluated the predictive values of the HAS-BLED, ORBIT, ATRIA, REACH, PARIS, and PRECISE-DAPT bleeding risk scores in patients with AF and ACS or undergoing PCI receiving both anticoagulant and antiplatelet therapy.
Do bleeding risk scores accurately predict bleeding in patients with AF and ACS or undergoing PCI on anticoagulant and antiplatelet therapy?
Cohort (n=930)
Do bleeding risk scores accurately predict bleeding in patients with AF and ACS or undergoing PCI on anticoagulant and antiplatelet therapy?
p-value: p=0.008
Commonly used bleeding risk scores like HAS-BLED perform poorly in patients with AF and ACS/PCI on combination antithrombotic therapy, suggesting a need for population-specific risk models.
May question HAS-BLED accuracy in AF/ACS/PCI on combination therapy; leaves open validation of tailored models before clinical adoption.
This study aims to evaluate the predictive values of the HAS-BLED, ORBIT, ATRIA, REACH, PARIS, and PRECISE-DAPT scores in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) who received both anticoagulant and antiplatelet therapy. 930 patients were consecutively recruited and followed up for 1 year. The primary endpoints were BARC class ≥3 bleeding and BARC class ≥2 bleeding. BARC class ≥3 bleeding occurred in 36 patients(3.9%), while BARC class ≥2 bleeding was seen in 134 patients (14.4%). The predictive performance of the HAS-BLED score for BARC class ≥3 bleeding was unsatisfactory (c-statistic = 0.575). The discrimination of the ATRIA, ORBIT, PARIS, and PRECISE-DAPT scores was also low-to-moderate. The REACH score was useless in bleeding risk stratification for this population. Multivariable logistic regression indicated that previous bleeding events and hemoglobin were two independent predictors of BARC class ≥3 bleeding. Compared to the HAS-BLED score, the model constructed by previous bleeding events and hemoglobin displayed a significant improvement in bleeding risk prediction [c-statistics: 0.704 vs. 0.575 (p = .008), NRI = 0.662,IDI = 0.049]. In patients with AF and ACS or undergoing PCI who received anticoagulant+antiplatelet therapy, the HAS-BLED, ORBIT, ATRIA, REACH, PARIS, and PRECISE-DAPT scores displayed only low-to-moderate performance in predicting BARC class≥3 bleeding. Future studies are required to develop more reliable scoring systems for bleeding risk evaluation in this population.
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Lyu et al. (2022) conducted a cohort in Atrial fibrillation and acute coronary syndrome or undergoing percutaneous coronary intervention (n=930). Bleeding risk scores (HAS-BLED, ORBIT, ATRIA, REACH, PARIS, PRECISE-DAPT) vs. Model constructed by previous bleeding events and hemoglobin was evaluated on BARC class ≥3 bleeding and BARC class ≥2 bleeding (p=0.008). A novel model using previous bleeding and hemoglobin outperformed the HAS-BLED score in predicting BARC class ≥3 bleeding (c-statistic 0.704 vs 0.575, p=0.008).
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