Scores predicting bleeding risk in AF

Scores predicting bleeding risk in AF

Anticoagulation is vital for reducing the risk of stroke in atrial fibrillation (AF). There are several scores predicting bleeding risk in AF. These can be used to weigh between the need for anticoagulation and the risk of bleeding with it while taking an individualized decision.

HAS-BLED: Hypertension, Abnormal liver or renal function, Stroke, Bleeding, Labile INRs, Elderly (>65 years), Drugs or Ethanol Abuse (1 point each). Maximum score possible is 9.

HEMORR₂HAGES: (Hepatic or Renal Disease, Ethanol Abuse, Malignancy History, Older than age 75, Reduced platelet count or function, Rebleeding risk, Hypertension, Anemia, Genetic factors (CYP2C9 single nucleotide polymorphisms), Excessive fall risk, Stroke history

ATRIA: Anemia, severe renal disease, Age 75 or older, Any prior hemorrhage diagnosis, Hypertension history

ORBIT: Outcomes Registry for Better Informed Treatment

In a post hoc analysis of clinically relevant and major bleeding in the around 2300 patients on warfarin in the AMADEUS trial, HAS-BLED score was shown to be better performing than ATRIA and ORBIT scores [1]. They could improve the predictive value of ATRIA and ORBIT by adding the time in therapeutic range (TTR) of warfarin to the scores.

References

1. Senoo K, Proietti M, Lane DA, Lip GY. Evaluation of the HAS-BLED, ATRIA, and ORBIT Bleeding Risk Scores in Patients with Atrial Fibrillation Taking Warfarin. Am J Med. 2016 Jun;129(6):600-7