Geoffrey D Barnes1, Xiaokui Gu2, Brian Haymart2, Eva Kline-Rogers2, Steve Almany3, Jay Kozlowski4, Dennis Besley5, Gregory D Krol6, James B Froehlich2, Scott Kaatz7. 1. Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI. Electronic address: gbarnes@umich.edu. 2. Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI. 3. William Beaumont Hospital, Troy, MI. 4. Huron Valley Sinai Hospital, Commerce, MI. 5. West Michigan Heart, Grand Rapids, MI. 6. Henry Ford Hospital, Detroit, MI. 7. Hurley Medical Center, Flint, MI.
Abstract
INTRODUCTION: Guidelines recommend the assessment of stroke and bleeding risk before initiating warfarin anticoagulation in patients with atrial fibrillation. Many of the elements used to predict stroke also overlap with bleeding risk in atrial fibrillation patients and it is tempting to use stroke risk scores to efficiently estimate bleeding risk. Comparison of stroke risk scores to bleeding risk scores to predict bleeding has not been thoroughly assessed. METHODS: 2600 patients followed at seven anticoagulation clinics were followed from October 2009-May 2013. Five risk models (CHADS2, CHA2DS2-VASc, HEMORR2HAGES, HAS-BLED and ATRIA) were retrospectively applied to each patient. The primary outcome was the first major bleeding event. Area under the ROC curves were compared with C statistic and net reclassification improvement (NRI) analysis was performed. RESULTS: 110 patients experienced a major bleeding event in 2581.6 patient-years (4.5%/year). Mean follow up was 1.0±0.8years. All of the formal bleeding risk scores had a modest predictive value for first major bleeding events (C statistic 0.66-0.69), performing better than CHADS2 and CHA2DS2-VASc scores (C statistic difference 0.10 - 0.16). NRI analysis demonstrated a 52-69% and 47-64% improvement of the formal bleeding risk scores over the CHADS2 score and CHA2DS2-VASc score, respectively. CONCLUSIONS: The CHADS2 and CHA2DS2-VASc scores did not perform as well as formal bleeding risk scores for prediction of major bleeding in non-valvular atrial fibrillation patients treated with warfarin. All three bleeding risk scores (HAS-BLED, ATRIA and HEMORR2HAGES) performed moderately well.
INTRODUCTION: Guidelines recommend the assessment of stroke and bleeding risk before initiating warfarin anticoagulation in patients with atrial fibrillation. Many of the elements used to predict stroke also overlap with bleeding risk in atrial fibrillationpatients and it is tempting to use stroke risk scores to efficiently estimate bleeding risk. Comparison of stroke risk scores to bleeding risk scores to predict bleeding has not been thoroughly assessed. METHODS: 2600 patients followed at seven anticoagulation clinics were followed from October 2009-May 2013. Five risk models (CHADS2, CHA2DS2-VASc, HEMORR2HAGES, HAS-BLED and ATRIA) were retrospectively applied to each patient. The primary outcome was the first major bleeding event. Area under the ROC curves were compared with C statistic and net reclassification improvement (NRI) analysis was performed. RESULTS: 110 patients experienced a major bleeding event in 2581.6 patient-years (4.5%/year). Mean follow up was 1.0±0.8years. All of the formal bleeding risk scores had a modest predictive value for first major bleeding events (C statistic 0.66-0.69), performing better than CHADS2 and CHA2DS2-VASc scores (C statistic difference 0.10 - 0.16). NRI analysis demonstrated a 52-69% and 47-64% improvement of the formal bleeding risk scores over the CHADS2 score and CHA2DS2-VASc score, respectively. CONCLUSIONS: The CHADS2 and CHA2DS2-VASc scores did not perform as well as formal bleeding risk scores for prediction of major bleeding in non-valvular atrial fibrillationpatients treated with warfarin. All three bleeding risk scores (HAS-BLED, ATRIA and HEMORR2HAGES) performed moderately well.
Authors: Andrew Putnam; Xiaokui Gu; Brian Haymart; Eva Kline-Rogers; Steve Almany; Jay Kozlowski; Gregory D Krol; Scott Kaatz; James B Froehlich; Geoffrey D Barnes Journal: J Thromb Thrombolysis Date: 2015-11 Impact factor: 2.300
Authors: Jacques D Donzé; Mark V Williams; Edmondo J Robinson; Eyal Zimlichman; Drahomir Aujesky; Eduard E Vasilevskis; Sunil Kripalani; Joshua P Metlay; Tamara Wallington; Grant S Fletcher; Andrew D Auerbach; Jeffrey L Schnipper Journal: JAMA Intern Med Date: 2016-04 Impact factor: 21.873
Authors: Geoffrey D Barnes; Eva Kline-Rogers; Christopher Graves; Eric Puroll; Xiaokui Gu; Kevin Townsend; Ellen McMahon; Terri Craig; James B Froehlich Journal: J Thromb Thrombolysis Date: 2018-07 Impact factor: 2.300
Authors: Ethan D Borre; Adam Goode; Giselle Raitz; Bimal Shah; Angela Lowenstern; Ranee Chatterjee; Lauren Sharan; Nancy M Allen LaPointe; Roshini Yapa; J Kelly Davis; Kathryn Lallinger; Robyn Schmidt; Andrzej Kosinski; Sana M Al-Khatib; Gillian D Sanders Journal: Thromb Haemost Date: 2018-10-30 Impact factor: 6.681