Use of Simplified HAS-BLED Score for Predicting Bleeding Events in Anticoagulated Patients with Atrial Fibrillation
Komsing Methavigul MD, FRCPT, FAsCC¹
Affiliation : ¹ Department of Cardiology, Central Chest Institute of Thailand, Nonthaburi, Thailand
Objective : To demonstrate bleeding risk prediction of simplified HAS-BLED (sHAS-BLED) score in anticoagulated patients with atrial fibrillation (AF).
Materials and Methods : AF patients receiving warfarin were retrospectively recruited in Central Chest Institute of Thailand between October 2012 and December 2017. The main outcome was total bleeding including major bleeding, clinically relevant non-major bleeding or minor bleeding. The chi-square test or Fisher’s exact test was used to compare the main outcome between sHAS-BLED and conventional HAS-BLED (cHAS-BLED) scores. A sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of sHAS-BLED were calculated. The discrimination performances of sHAS-BLED and cHAS-BLED scores were demonstrated with c-statistics.
Results : One hundred ten patients were recruited. The mean age was 70.53±9.58 years. The average sHAS-BLED and cHAS-BLED scores were 2.23±0.79 and 1.95±0.83, respectively. The patients with sHAS-BLED score of 3 or more had 15 total bleeding events (37.50%) while those with score of less than 3 had 13 total bleeding events (18.57%). Those with sHAS-BLED score of 3 or more had more total bleeding than those with score of less than 3 with statistical significance (odds ratio 2.63; 95% CI 1.09 to 6.25; p=0.049). A sensitivity, specificity, PPV, and NPV of sHAS- BLED score were 53.57%, 69.51%, 37.50%, and 81.43%, respectively. The discrimination performances of sHAS-BLED and cHAS-BLED scores were demonstrated with c-statistics of 0.65 and 0.67, respectively.
Conclusion : The sHAS-BLED score can be used for bleeding risk prediction in anticoagulated AF patients compared with cHAS-BLED score.
Received 2 November 2020 | Revised 15 February 2021 | Accepted 15 February 2021
doi.org/10.35755/jmedassocthai.2021.05.12142
Keywords : Simplified HAS-BLED, Atrial fibrillation, Anticoagulant, Bleeding, SAMe-TT₂R₂
