Key result
New ABS model outperforms existing scores in predicting major AF bleeding with a 0.68 c-statistic.
Why the study?
No scores presently exist to predict major bleeding in atrial fibrillation populations using direct oral anticoagulants.
Does the Anticoagulation-specific Bleeding Score (ABS) better predict major bleeding in patients with non-valvular atrial fibrillation initiating oral anticoagulation compared to existing scores?
Cohort (n=200,368)
Does the Anticoagulation-specific Bleeding Score (ABS) better predict major bleeding in patients with non-valvular atrial fibrillation initiating oral anticoagulation compared to existing scores?
Effect estimate: c-statistic 0.68 (95% CI 0.67-0.69)
The newly developed Anticoagulation-specific Bleeding Score (ABS) provides modest but improved prediction of major bleeding risk in AF patients starting oral anticoagulation, accounting for the differential risk between DOACs and warfarin.
Should not yet change bleeding risk assessment in AF; hypothesis-generating for ABS outperforming existing scores.
BACKGROUND: No scores presently exist to predict bleeding in atrial fibrillation (AF) populations using direct oral anticoagulants (DOACs). We used data from two independent healthcare claims databases to develop and validate a predictive model of major bleeding in a contemporary AF population. METHODS: Patients with non-valvular AF initiating oral anticoagulation were identified in the MarketScan databases from 2007-2014. Using Cox regression models in 1000 bootstrapped samples, we developed a model that selected variables predicting major bleeding in the first year after anticoagulant initiation. The final model was validated in patients with non-valvular AF in the Optum Clinformatics database in the period 2009-2015. The discriminative ability of existing bleeding scores were individually evaluated and compared with the new bleeding model termed Anticoagulation-specific Bleeding Score (ABS) in both MarketScan and Optum. RESULTS: Among 119,083 patients with AF initiating oral anticoagulation in the derivation cohort, 4,030 experienced a bleeding event. The variable selection model identified 15 variables (including individual type of oral anticoagulant) associated with major bleeding. Discrimination of the model was modest [c-statistic 0.68, 95% confidence interval (CI) 0.67-0.69]. The model was subsequently applied to 81,285 AF patients in the validation data set (3,238 bleeding events), showing similar discrimination (c-statistic 0.68, 95% CI 0.67-0.69). In both cohorts, the predictive performance of the ABS was better than the existing models for bleeding prediction in AF. CONCLUSIONS: We developed a model that uses administrative healthcare data for the identification of AF patients at higher risk of bleeding after initiation of oral anticoagulation, taking into account the lower bleeding risk in DOAC compared to warfarin users.
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Claxton et al. (2018) conducted a cohort in Non-valvular atrial fibrillation (n=200,368). Anticoagulation-specific Bleeding Score (ABS) vs. Existing bleeding risk scores (HEMORR2HAGES, HAS-BLED, ATRIA, ORBIT) was evaluated on Discrimination (c-statistic) for predicting major bleeding in the first year after anticoagulant initiation (c-statistic 0.68, 95% CI 0.67-0.69). The newly developed Anticoagulation-specific Bleeding Score (ABS) demonstrated modest discrimination (c-statistic 0.68) for predicting major bleeding in AF patients initiating oral anticoagulants, outperforming existing risk scores.
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