Utility of the HAS-BLED score for risk stratification of patients with acute coronary syndrome

Castini, Diego; Persampieri, Simone; Sabatelli, Ludovico; Erba, Massimo; Ferrante, Giulia; Valli, F; Centola, Marco; Carugo, Stefano

doi:10.1007/s00380-019-01405-1

Cited by 14 publications

(13 citation statements)

References 43 publications

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“…The risk of bleeding was calculated using the HAS-BLED score [12], regardless of the diagnosis of atrial fibrillation or the prescription of anticoagulant therapy. This measuring scale exhibits good predictive value for intracranial bleeding in anticoagulated patients with atrial fibrillation, although it has also been used for patients without atrial fibrillation and with acute coronary disease [13]. The scale, which has been well validated worldwide and is easy to apply, contains the following variables: age > 65 years; uncontrolled hypertension defined as a mean SBP ≥ 160 mmHg among those with hypertension; abnormal kidney and/or liver function; previous ischaemic stroke; history of bleeding or predisposition; labile INR, defined as time in the therapeutic range during the previous 6 months < 60% (only for patients receiving vitamin K antagonists); and concomitant use of medications (antiplatelet drugs and/or nonsteroidal anti-inflammatory drug [NSAIDs]) and/or alcohol consumption.…”

Section: Variablesmentioning

confidence: 99%

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Lorman-Carbo¹,

Clúa-Espuny²,

Muria-Subirats³

et al. 2021

BMC Geriatr

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Background Demographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP). Methods This is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/12/2017 in primary care without a history of previous ICH episode. The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The main variable was the ICH episode during the study period. Demographic, clinical, functional, cognitive and pharmacological variables were included. Descriptive and logistic regression analyses were carried out to identify the variables associated with suffering an ICH. The independent risk factors were obtained from logistic regression models, ruling out the variables included in the HAS-BLED score, to avoid duplication effects. Results are presented as odds ratio (OR) and 95% confidence interval (CI). The analysis with the resulting model was also stratified by sex. Results 161 (4.4%) participants suffered an ICH episode. Mean age 87 ± 9 years; 55.9% women. The ICH incidence density was 151/10000 person-years [95%CI 127–174], without differences by sex. Related to subjects without ICH, presented a higher prevalence of arterial hypertension (83.2% vs. 74.9%; p = 0.02), hypercholesterolemia (55.3% vs. 47.4%, p = 0.05), cardiovascular disease (36.6% vs. 28.9%; p = 0.03), and use of antiplatelet drugs (64.0% vs. 52.9%; p = 0.006). 93.2% had a HAS-BLED score ≥ 3. The independent risk factors for ICH were identified: HAS-BLED ≥3 [OR 3.54; 95%CI 1.88–6.68], hypercholesterolemia [OR 1.62; 95%CI 1.11–2.35], and cardiovascular disease [OR 1.48 IC95% 1.05–2.09]. The HAS_BLED ≥3 score showed a high sensitivity [0.93 CI95% 0.89–0.97] and negative predictive value [0.98 (CI95% 0.83–1.12)]. Conclusions In the CCP subgroup the incidence density of ICH was 5–60 times higher than that observed in elder and general population. The use of bleeding risk score as the HAS-BLED scale could improve the preventive approach of those with higher risk of ICH. Trial registration This study was retrospectively registered in ClinicalTrials.gov (NCT03247049) on August 11/2017.

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Section: Variablesmentioning

confidence: 99%

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Lorman-Carbo¹,

Clúa-Espuny²,

Muria-Subirats³

et al. 2021

BMC Geriatr

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“…Interestingly, HAS-BLED scores may offer a promising tool to assess bleeding risk. This risk-assessment tool was initially developed to evaluate bleeding risk in anti-coagulated patients affected by atrial fibrillation [ 32 ], and later was applied for patients with acute VTE [ 33 – 35 ], acute coronary syndrome (ACS) [ 36 , 37 ], intracranial hemorrhage (ICH) [ 38 , 39 ], postoperative AC after cardiac and vascular interventions [ 40 , 41 ], etc. A score of 0 indicates low risk, 1–2 indicates moderate risk, and ≥ 3 indicates high risk.…”

Section: Discussionmentioning

confidence: 99%

Empiric use of anticoagulation in hospitalized patients with COVID-19: a propensity score-matched study of risks and benefits

Gutiérrez

Carlos

et al. 2021

Biomark Res

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Background Hospitalized patients with COVID-19 demonstrate a higher risk of developing thromboembolism. Anticoagulation (AC) has been proposed for high-risk patients, even without confirmed thromboembolism. However, benefits and risks of AC are not well assessed due to insufficient clinical data. We performed a retrospective analysis of outcomes from AC in a large population of COVID-19 patients. Methods We retrospectively reviewed 1189 patients hospitalized for COVID-19 between March 5 and May 15, 2020, with primary outcomes of mortality, invasive mechanical ventilation, and major bleeding. Patients who received therapeutic AC for known indications were excluded. Propensity score matching of baseline characteristics and admission parameters was performed to minimize bias between cohorts. Results The analysis cohort included 973 patients. Forty-four patients who received therapeutic AC for confirmed thromboembolic events and atrial fibrillation were excluded. After propensity score matching, 133 patients received empiric therapeutic AC while 215 received low dose prophylactic AC. Overall, there was no difference in the rate of invasive mechanical ventilation (73.7% versus 65.6%, p = 0.133) or mortality (60.2% versus 60.9%, p = 0.885). However, among patients requiring invasive mechanical ventilation, empiric therapeutic AC was an independent predictor of lower mortality (hazard ratio [HR] 0.476, 95% confidence interval [CI] 0.345–0.657, p < 0.001) with longer median survival (14 days vs 8 days, p < 0.001), but these associations were not observed in the overall cohort (p = 0.063). Additionally, no significant difference in mortality was found between patients receiving empiric therapeutic AC versus prophylactic AC in various subgroups with different D-dimer level cutoffs. Patients who received therapeutic AC showed a higher incidence of major bleeding (13.8% vs 3.9%, p < 0.001). Furthermore, patients with a HAS-BLED score of ≥2 had a higher risk of mortality (HR 1.482, 95% CI 1.110–1.980, p = 0.008), while those with a score of ≥3 had a higher risk of major bleeding (Odds ratio: 1.883, CI: 1.114–3.729, p = 0.016). Conclusion Empiric use of therapeutic AC conferred survival benefit to patients requiring invasive mechanical ventilation, but did not show benefit in non-critically ill patients hospitalized for COVID-19. Careful bleeding risk estimation should be pursued before considering escalation of AC intensity.

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“…Interestingly, HAS-BLED scores may offer a promising tool to assess bleeding risk. This risk-assessment tool was initially developed to evaluate bleeding risk in anti-coagulated patients affected by atrial brillation [31], and later was applied for patients with acute VTE [32][33][34], acute coronary syndrome (ACS) [35,36], intracranial hemorrhage (ICH) [37,38], postoperative AC after cardiac and vascular interventions [39,40], etc. A score of 0 indicates low risk, 1-2 indicates moderate risk, and ≥3 indicates high risk.…”

Section: Discussionmentioning

confidence: 99%

Empiric use of Anticoagulation in Hospitalized Patients with COVID-19: A Propensity Score-Matched Study of Risks and Benefits

Gutiérrez

Carlos

et al. 2021

Preprint

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Background: Hospitalized patients with COVID-19 demonstrate a higher risk of developing thromboembolism. Anticoagulation (AC) has been proposed for high-risk patients, even without confirmed thromboembolism. However, benefits and risks of AC are not well assessed due to insufficient clinical data. We performed a retrospective analysis of outcomes from AC in a large population of COVID-19 patients. Methods: We retrospectively reviewed 1189 patients hospitalized for COVID-19 between March 15 and May 15, 2020, with primary outcomes of mortality, invasive mechanical ventilation, and major bleeding. Patients who received therapeutic AC for known indications were excluded. Propensity score matching of baseline characteristics and admission parameters was performed to minimize bias between cohorts. Results: The analysis cohort included 973 patients. Forty-four patients who received therapeutic AC for confirmed thromboembolic events and atrial fibrillation were excluded. After propensity score matching, 133 patients received empiric therapeutic AC while 215 received low dose prophylactic AC. Overall, there was no difference in the rate of invasive mechanical ventilation (73.7% versus 65.6%, p = 0.133) or mortality (60.2% versus 60.9%, p = 0.885). However, among patients requiring invasive mechanical ventilation, empiric therapeutic AC was an independent predictor of lower mortality (hazard ratio [HR] 0.476, 95% confidence interval [CI] 0.345-0.657, p < 0.001) with longer median survival (14 days vs 8 days, p < 0.001), but these associations were not observed in the overall cohort (p = 0.063). Additionally, no significant difference in mortality was found between patients receiving empiric therapeutic AC versus prophylactic AC in various subgroups with different D-dimer level cutoffs. Patients who received therapeutic AC showed a higher incidence of major bleeding (13.8% vs 3.9%, p < 0.001). Furthermore, patients with a HAS-BLED score of ≥2 had a higher risk of mortality (HR 1.482, 95% CI 1.110-1.980, p = 0.008), while those with a score of ≥3 had a higher risk of major bleeding (Odds ratio: 1.883, CI: 1.114-3.729, p = 0.016). Conclusion: Empiric use of therapeutic AC conferred survival benefit to patients requiring invasive mechanical ventilation, but did not show benefit in non-critically ill patients hospitalized for COVID-19. Careful bleeding risk estimation should be pursued before considering escalation of AC intensity.

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Utility of the HAS-BLED score for risk stratification of patients with acute coronary syndrome

Cited by 14 publications

References 43 publications

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Empiric use of anticoagulation in hospitalized patients with COVID-19: a propensity score-matched study of risks and benefits

Empiric use of Anticoagulation in Hospitalized Patients with COVID-19: A Propensity Score-Matched Study of Risks and Benefits

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