Evaluation of the Age, Biomarkers, and Clinical History–Bleeding Risk Score in Patients With Atrial Fibrillation With Combined Aspirin and Anticoagulation Therapy Enrolled in the ARISTOTLE and RE-LY Trials

Abstract

Key Points Question Is the recently developed ABC (age, biomarkers, and clinical history)–bleeding risk score for patients with atrial fibrillation (AF) useful to identify patients with different risks of bleeding during concomitant aspirin and anticoagulation therapy? Findings This cohort study examined a total of 24 349 patients with AF from 2 randomized clinical trials and found that the ABC-bleeding risk score identified patients with different risks of bleeding when combining aspirin and oral anticoagulation. Meaning The ABC-bleeding risk score may be a useful tool for decision support concerning intensity and duration of combination antithrombotic treatment in patients with AF and coronary artery disease.

Assessment and Mitigation of Bleeding Risk in Atrial Fibrillation and Venous Thromboembolism: Executive Summary of a European and Asia-Pacific Expert Consensus Paper

“…The ABC (Atrial fibrillation Better Care) bleeding risk score, which includes blood biomarkers of bleeding including growth differentiation factor-15 (GDF-15), troponin T, and hemoglobin, has been shown to statistically better predict bleeding than clinical factor-based bleeding risk scores in patients with AF receiving OAC or taking both OAC and antiplatelet therapy (APT), and in different geographic regions, 43 44 45 46 but this was not confirmed in another study. 47 The consecutive addition of different blood-based biomarkers only slightly enhanced the predictive ability of the HAS-BLED score for major bleeding.…”

“…26 A Taiwanese registry of 24,990 AF patients showed that by 1 year, around 21% had acquired at least one new bleeding risk factor, including hypertension (5.84%), stroke (5.33%), bleeding (5.06%), concomitant use of antiplatelet agents or NSAIDs (4.34%), and renal (3.08%) or liver (2.22%) impairment. 28 Data from ORBIT AF shows that over a 2-year follow-up, about a quarter of patients had >20% decline in estimated glomerular filtration rate (eGFR) and The ABC (Atrial fibrillation Better Care) bleeding risk score, which includes blood biomarkers of bleeding including growth differentiation factor-15 (GDF-15), troponin T, and hemoglobin, has been shown to statistically better predict bleeding than clinical factor-based bleeding risk scores in patients with AF receiving OAC or taking both OAC and antiplatelet therapy (APT), and in different geographic regions, [43][44][45][46] but this was not confirmed in another study. 47 The consecutive addition of different blood-based biomarkers only slightly enhanced the predictive ability of the HAS-BLED score for major bleeding.…”

Growth Differentiation Factor-15 Based ABC (Age, Biomarkers, Clinical History)-AF (Atrial Fibrillation)-Bleeding Risk Score for Elderly Patients with Nonvalvular Atrial Fibrillation

“…Growth differentiation factor-15 (GDF-15) is a novel cardiac biomarker [2,3], a strong predictor of bleeding in patients with NVAF, and evaluates bleeding, stroke, and death risk in atrial fibrillation (AF) [4][5][6]. Studies [6][7][8] showed that GDF-15 has better stability and continuity as a novel cardiac biomarker, which has become a hotspot of clinical research for bleeding risk evaluation and clinical application in patients with atrial fibrillation [9,10].…”

“…Growth differentiation factor-15 (GDF-15) is a novel cardiac biomarker [2,3], a strong predictor of bleeding in patients with NVAF, and evaluates bleeding, stroke, and death risk in atrial fibrillation (AF) [4][5][6]. Studies [6][7][8] showed that GDF-15 has better stability and continuity as a novel cardiac biomarker, which has become a hotspot of clinical research for bleeding risk evaluation and clinical application in patients with atrial fibrillation [9,10]. e novel ABC (age, biomarkers, and clinical history) AF bleeding risk scores outperform the HAS-BLED bleeding risk score for major bleeding (MB) patients with NVAF receiving oral anti-coagulation in the clinical trial cohort such as ARISTOTLE [6], RE-LY [6], and ENGAGE AF-TIMI 48 [8] indicated that the ABC-AF bleeding risk score outperformed the traditional HAS-BLED score.…”

“…Studies [6][7][8] showed that GDF-15 has better stability and continuity as a novel cardiac biomarker, which has become a hotspot of clinical research for bleeding risk evaluation and clinical application in patients with atrial fibrillation [9,10]. e novel ABC (age, biomarkers, and clinical history) AF bleeding risk scores outperform the HAS-BLED bleeding risk score for major bleeding (MB) patients with NVAF receiving oral anti-coagulation in the clinical trial cohort such as ARISTOTLE [6], RE-LY [6], and ENGAGE AF-TIMI 48 [8] indicated that the ABC-AF bleeding risk score outperformed the traditional HAS-BLED score. e ABC-AF bleeding score was recommended in European atrial fibrillation management guidelines [7] since 2016.…”