Search

Purpose The CHA2 DS2 -VaSc and HAS-BLED risk scores are commonly used in the studies of oral anticoagulants (OACs). The best ways to map these scores to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes is unclear, as is how they perform in various types of OAC users. We aimed to assess the distributions of CHA2 DS2 -VaSc and HAS-BLED scores and C-statistics for outcome prediction in the ICD-10-CM era using different mapping strategies. Methods We compared the distributions of CHA2 DS2 -VaSc and HAS-BLED scores from various mapping strategies in atrial fibrillation patients before, during, and after ICD-10-CM transition. We estimated the C-statistics predicting the 90-day risk of hospitalized stroke (for CHA2 DS2 -VaSc) or hospitalized bleeding (for HAS-BLED) in patients identified at least 6 months after the ICD-10-CM transition, overall and by anticoagulant type. Results Forward-backward mapping produced higher CHA2 DS2 -VaSc and HAS-BLED scores in the ICD-10-CM era compared to the ICD-9-CM era: the mean difference was 0.074 (95% confidence interval 0.064-0.085) for CHA2 DS2 -VaSc and 0.055 (0.048-0.062) for HAS-BLED. Both scores had higher C-statistics in patients taking no OACs (0.697 [0.677-0.717] for CHA2 DS2 -VaSc; 0.719 [0.702-0.737] for HAS-BLED) or direct OACs (0.695 [0.654-0.735] for CHA2 DS2 -VaSc; 0.700 [0.673-0.728] for HAS-BLED) than those taking warfarin (0.655 [0.613-0.697] for CHA2 DS2 -VaSc; 0.663 [0.6320.695] for HAS-BLED). Conclusions Existing mapping strategies generally preserved the distributions of CHA2 DS2 -VaSc and HAS-BLED scores after ICD-10-CM transition. Both scores performed better in patients on no OACs or direct OACs than patients on warfarin.

Background Oral anticoagulant drugs are proven to prevent thromboembolism in patients with atrial fibrillation (AF). To date, HAS‐BLED score is used to assess bleeding risk. This study was conducted to compare simplified HAS‐BLED (sHAS‐BLED) with conventional HAS‐BLED (cHAS‐BLED) scores. Methods This retrospective study recruited patients with AF receiving warfarin among July 2013 to December 2018 in Central Chest Institute of Thailand. The cHAS‐BLED score used the time in therapeutic range less than 70% as labile INR, whereas sHAS‐BLED score used SAMe‐TT2R2 score of 3 or more as a substitute for labile INR. A paired Student's t test was used to compare sHAS‐BLED and cHAS‐BLED. The Pearson's correlation was used to assess the correlation of sHAS‐BLED to cHAS‐BLED scores. The Bland‐Altman plot was used to confirm the agreement of individual sHAS‐BLED to cHAS‐BLED score. Results A total of 126 AF patients were enrolled. The average age, SAMe‐TT2R2 score, and cHAS‐BLED score were 70.52 ± 10.37 years, 3.53 ± 1.03, and 2.03 ± 0.95, respectively. The sHAS‐BLED score was not statistically significantly different compared with cHAS‐BLED score (P = .08). The sHAS‐BLED and cHAS‐BLED scores had a very strong correlation with a correlation coefficient of .86 (P

Aim Evidence on antithrombotic therapy use in centenarians diagnosed with atrial fibrillation (AF) is sparse. Our objective was to investigate a possible underprescribing in centenarians relative to younger cohorts of the oldest-old. We assumed lower AF rates; and, within AF patients, lower use of anticoagulants in those who died as centenarians (aged ≥100 years) than in those who died aged in their 80s (≥80 years) or 90s (≥90 years). Methods The present study was a quarterly structured cohort study over the 6 years before death using administrative data from German institutionalized and non-institutionalized insured patients (whole sample n = 1398 and subsample of AF patients n = 401 subclassified according to age-of-death groups [≥80, ≥90, ≥100 years]). AF, medication, stroke risk (Congestive heart failure; Hypertension; 2 × Age ≥75 years; Diabetes mellitus; 2 × Stroke; Vascular disease; Age 65-74 years; Sex [female] (CHA2 DS2 -VASc)) and risk of major bleeding (Hypertension; Abnormal renal and liver function; Stroke; Bleeding; Labile International Normalized Ratio [omitted in the present analysis]; Elderly; Drugs or alcohol (HAS-BLED)) were calculated. Generalized estimation equations were used to model the trajectories. Results Half a year before death (T1), AF rates were higher in patients aged ≥80 years (31.8%) and ≥90 years (30.6%) compared with patients aged ≥100 years (22.4%), whereas there were no significant differences between age groups 6 years before death (T0). Of all AF patients with AF at T1, 26.7% received anticoagulants; 11.2% vitamin K antagonists; 15.7% non-vitamin K antagonist oral anticoagulants; and 17.5% platelet inhibitors; yet 58.1% received none of these drugs. Centenarians received significantly fewer anticoagulants compared with the other age groups. Prescriptions of anticoagulants were not associated with CHA2 DS2 -VASc with and without adjustment for HAS-BLED. Conclusions The present findings highlight the need for more appropriate use of anticoagulation therapy in older patients, as well as for new treatment guidelines taking the heterogeneity of very old patients into account. Geriatr Gerontol Int 2018; 18: 1634-1640.

Introduction Dabigatran, as compared with warfarin, was associated with lower rates of stroke and systemic embolism with similar rates of major hemorrhage. But it has a significantly higher risk of gastrointestinal bleeding (GIB). There are limited data on how to prevent GIB from dabigatran and what are the risk factors. Methods We performed a retrospective cohort study of patients with atrial fibrillation who have ever taken dabigatran for thromboprophylaxis from October 2010 to February 2013. Results A total of 247 patients were identified. There were 10 (4%) patients who developed GIB (6 (6.5%) in PPI/H2RA users vs 4 (2.6%) in non‐PPI/H2RA users; P = .184). History of GIB within 1 year prior to dabigatran initiation and HAS‐BLED score ≥3 are independent risk factors for GIB, with odds ratio of 25.14 (95% CI, 2.85‐221.47; P

The HAS-BLED model is widely utilized to assess patients' bleed risk prior to anticoagulant therapy including warfarin. Some of the variables assessed in the model are also known to influence warfarin control, commonly measured by time in therapeutic range (TTR). The aim of the study was to determine whether the HAS-BLED risk tool is a good predictor of bleed risk and warfarin control in deep vein thrombosis (DVT) patients. Retrospective data were collected for DVT warfarin care patients at Sullivan Nicolaides Pathology. Data included age, medical history and concurrent drug therapy to calculate HAS-BLED scores. INR results were used to calculate TTR with the Rosendaal method and mean TTR used for analysis and comparison. The eligible 533 patients had a mean TTR of 78.3%. Categorization according to HAS-BLED score resulted in 150 patients classified as low-risk, 331 as moderate-risk and 52 as high-risk with a haemorrhagic incidence per patient of 0.08, 0.53 and 0.54, respectively. Patients in the low-, moderate- and high-risk HAS-BLED categories had a mean TTR of 81%, 79% and 65%, respectively, with significant differences (p < 0.001) found in TTR between the low- and high-risk and moderate- and high-risk categories. In an Australian DVT population, the HAS-BLED score accurately predicts decreasing warfarin control with increasing risk category, and patients with scores ≥3 achieve poor control as indicated by a TTR

Introduction Current guidelines recommend continuation of dual anti-platelet therapy (DAPT) for 12 months after percutaneous coronary intervention (PCI). Recent studies have shown benefit in continuing DAPT beyond 12 months but at the risk of increase bleeding. To date, there has been little data on risk stratifying patients to determine who can continue DAPT beyond 12 months at minimal bleeding risk. Methods All patients who underwent drug-eluting stent (DES) placement from January 1, 2013 to September 30, 2014 were reviewed. Patients who had follow-up for at least 12 months, placement of 2nd generation everolimus-coated DES, and were on DAPT for at least 12 months were included. Patients with a history of atrial fibrillation, follow-up time less than 12 months, or were on concurrent oral anticoagulation therapy were excluded. Results Five hundred thirty-one patients were analyzed as described above. Two hundred two patients included in our study with 7 patients in the bleeding cohort and 195 patients in no-bleed cohort. The HAS-BLED score in patients who had a bleeding episode vs. those who did not was 3.29 vs. 2.24 (P value of 0.0009). Although not statistically significant, patients who had a bleeding episode were more likely to have renal dysfunction, alcohol use, be on prasugrel, and be on 325mg of aspirin. Conclusion The study shows that the HAS-BLED score can be of utility in risk stratifying patients in determining who can continue DAPT beyond 12 months. Furthermore, a HAS-BLED score of less than 2 may help guide extended DAPT beyond 12 months at minimal bleeding risk. © 2016 Wiley Periodicals, Inc.

As indications for TAVR expand, there is a need for predictive models of procedural complications. Application of the HAS-BLED score demonstrated patient comorbidities that contribute to increased bleeding events and mortality. Further adequately powered studies will be needed to validate the HAS-BLED score for use in the TAVR population or further elucidate important risk factor to incorporate into future predictive risk models.

Introduction Although recommendations for the antithrombotic management of atrial fibrillation (AF) are based on strong evidence, the European guidelines are not fully implemented into practice. Objectives The objective of this study is to analyse antithrombotic treatment in AF in Poland after the publication of the European Society of Cardiology Guidelines in 2012. Patients and Methods We retrospectively studied 1556 patients with AF from the Reference Cardiology University Centre in Poland in 2012–2014. Results CHA2DS2VASc and HAS-BLED scores were 3.5 ± 1.7 and 2.4 ± 1.1. Anti-vitamin K agent were prescribed in 59%, with non-vitamin K antagonist oral anticoagulants in 12%, acetylsalicylic acid (ASA) alone in 18%. Older patients (p

Our objective was to compare the diagnostic accuracy between the HAS-BLED score and any of HEMORR2 HAGES, ATRIA, CHADS2 , or CHA2 DS2 -VASc scores in anticoagulated patients with atrial fibrillation. We systematically searched the Cochrane Library, MEDLINE, PubMed, and Embase databases for relevant studies. Data were extracted and analyzed according to predefined clinical endpoints. Eleven studies were identified. Discrimination analysis demonstrates that HAS-BLED has no significant C-statistic differences for bleeding risk prediction compared with ATRIA or HEMORR2 HAGES, but it has significant differences compared with CHADS2 or CHA2 DS2 -VASc. The significant positive net reclassification improvement and integrated discrimination improvement values also show that HAS-BLED is superior to that of any of HEMORR2 HAGES, ATRIA, CHADS2 , or CHA2 DS2 -VASc scores. According to calibration analysis of HAS-BLED, it overpredicts the risk of bleeding in the low (risk ratio [RR]: 1.16, 95% confidence interval [CI]: 0.63-2.13, P = 0.64) risk stratification but underpredicts that in the moderate (RR: 0.66, 95% CI: 0.51-0.86, P = 0.002) and high (RR: 0.88, 95% CI: 0.70-1.10, P = 0.27) risk stratifications. The HAS-BLED score not only performs better than the HEMORR2 HAGES and ATRIA bleeding scores, but it also is superior to the CHADS2 and CHA2 DS2 -VASc stroke scores for bleeding prediction. The HAS-BLED score should be the optimal choice to assess major bleeding risk in clinical practice.

Stroke prevention is central to the management of patients with atrial fibrillation (AF). As effective stroke prophylaxis essentially requires oral anticoagulants, an understanding of the risks and benefits of oral anticoagulant therapy is needed. Although AF increases stroke risk 5-fold, this risk is not homogeneous. Many stroke risk factors also confer an increased risk of bleeding. Various stroke and bleeding risk-stratification schemes have been developed to help inform clinical decision-making. These scores were derived and validated in different study cohorts, ranging from highly selected clinical-trial cohorts to real-world populations. Thus, their performance and classification accuracy vary depending on their derivation cohort(s). In the present review, we provide an overview of currently available stroke and bleeding risk-stratification schemes. We particularly focus on the CHA2 DS2 -VASc and HAS-BLED schemes, as these are recommended by the latest European guidelines on AF management. Other risk-stratification schemes (eg, CHADS2 , R2 CHADS2 , ATRIA, HEMORR2 HAGES, QStroke) and their place in the decision-making are also considered.