Scores to Predict Major Bleeding Risk During Oral Anticoagulation Therapy: A Prospective Validation Study

Donzé, Jacques; Rodondi, Nicolas; Waeber, Gérard; Monney, Pierre; Cornuz, Jacques; Aujesky, Drahomir

doi:10.1016/j.amjmed.2012.04.005

Cited by 90 publications

(82 citation statements)

References 23 publications

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“…The first study evaluating the HAS-BLED score in VTE patients was performed in 663 elderly patients, and reported a poor c-statistic of 0.55 [52]. A second study, performed in 515 patients with various indications for the use of VKAs, reported a c-statistic of 0.57 for the HAS-BLED score for the entire population of VKA-users, without reporting the area under the curve for the VTE population separately [43]. In the third study, the HAS-BLED score was calculated in 223 patients with PE and 314 patients with DVT, who were treated with VKAs for a period of 6 months.…”

Section: Bleeding-prediction Scores Derived From Non-vte Patient Popumentioning

confidence: 99%

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

et al. 2014

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Diagnosis of venous thromboembolism (VTE) requires prompt treatment with anticoagulants in therapeutic doses. Since these drugs are associated with the occurrence of haemorrhage, identification of patients at increased risk of major bleeding is of utmost clinical importance for defining the optimal treatment regimen and duration of anticoagulation. Current suggested prediction scores for bleeding risk in VTE patients have been derived from observational studies of moderate quality, or from patients with various indications for therapeutic anticoagulation other than VTE. To date, none of the scores have been adequately validated in cohorts that underwent dedicated monitoring and independent adjudication of bleeding complications. In addition, while the scarce available evidence has focused on patients treated with heparins and/or vitamin K antagonists, risk stratification scores for bleeding complications in VTE patients treated with non-vitamin K dependent anticoagulants have not yet been developed. This clinically oriented review covers the incidence and risk factors of anticoagulation-related bleeding in VTE patients treated with different anticoagulant drugs as well as the available bleedingprediction scores. Further, we attempt to provide guidance for bleeding-prevention in clinical practice and speculate on developments in the near future that may fundamentally change our current thinking on VTE management. @ERSpublications Bleeding in VTE: no validated risk-prediction scores, no effective preventive measures: are NOACs the solution?

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Section: Bleeding-prediction Scores Derived From Non-vte Patient Popumentioning

confidence: 99%

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

et al. 2014

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“…9,10 However, probably, for a number of reasons, it is not yet sufficiently well defined to be (considered) the best among the mediocre. 11,12 Our data suggest that the reevaluation of hemorrhagic and thrombotic risk in these patients should be a precise role of the emergency physician. In our patients the percentage of those with Has-Bled≥3 was quite high at the time of the traumatic event, but nevertheless they were anticoagulated.…”

Section: Discussionmentioning

confidence: 87%

“…In our patients the percentage of those with Has-Bled≥3 was quite high at the time of the traumatic event, but nevertheless they were anticoagulated. Donzè et al 11 observed that in unselected patients the scores have little power to predict the risk of major bleeding and do not seem superior to the physicians' subjective evaluation; others authors 9 report that diabetes and heart failure are potential risk factors for bleeding, but are not included in the HASBled. White 13 comments that the risk of bleeding is dynamic and associated with multiple factors that often cannot be measured as intercurrent diseases, INR control, trauma and falls.…”

Section: Discussionmentioning

confidence: 99%

Traumatic events involving elderly patients treated with anticoagulants for atrial fibrillation: the downside of stroke prevention

Riccardi¹,

Minuto²,

Ghinatti³

et al. 2016

Emerg Care J

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A group of oral anticoagulant-treated patients affected by permanent atrial fibrillation was evaluated after their access to the emergency room as a result of a traumatic accident. In these patients, the re-evaluation of their risk of thromboembolism and bleeding was performed together with the evaluation of their risk of falling and institutionalization. Results show that the emergency department identifies a cohort of very elderly frail patients, who should be carefully reconsidered for anticoagulant therapy after a traumatic event.

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“…However, all of these risk scores have performed relatively poorly in subsequent cohorts, and none is better than physician estimation alone. 27,28 Nonetheless, there is concern that clinicians are using these scores inappropriately, in an attempt to determine a net clinical benefit of OAC therapy in individual circumstances. The bleeding-risk scores have not been validated for this use; rather, they are designed to aid the clinician in identifying potentially modifiable risk factors such as high blood pressure, abnormal renal or liver function, potential medication interactions, and alcohol use.…”

Section: Underuse Of Oral Anticoagulants For Nonvalvular Atrial Fibrimentioning

confidence: 99%

Underuse of Oral Anticoagulants for Nonvalvular Atrial Fibrillation: Past, Present, and Future

Wehbe¹,

Yadlapati²

2016

Texas Heart Institute Journal

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Scores to Predict Major Bleeding Risk During Oral Anticoagulation Therapy: A Prospective Validation Study

Cited by 90 publications

References 23 publications

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

Traumatic events involving elderly patients treated with anticoagulants for atrial fibrillation: the downside of stroke prevention

Underuse of Oral Anticoagulants for Nonvalvular Atrial Fibrillation: Past, Present, and Future

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