Scientific article
OA Policy
English

Novel bleeding risk score for patients with atrial fibrillation on oral anticoagulants, including direct oral anticoagulants

Published inJournal of thrombosis and haemostasis, vol. 19, no. 4, p. 931-940
Publication date2021-04
First online date2021-02-24
Abstract

Objective: Balancing bleeding risk and stroke risk in patients with atrial fibrillation (AF) is a common challenge. Though several bleeding risk scores exist, most have not included patients on direct oral anticoagulants (DOACs). We aimed at developing a novel bleeding risk score for patients with AF on oral anticoagulants (OAC) including both vitamin K antagonists (VKA) and DOACs. Methods: We included patients with AF on OACs from a prospective multicenter cohort study in Switzerland (SWISS-AF). The outcome was time to first bleeding. Bleeding events were defined as major or clinically relevant non-major bleeding. We used backward elimination to identify bleeding risk variables. We derived the score using a point score system based on the β-coefficients from the multivariable model. We used the Brier score for model calibration (<0.25 indicating good calibration), and Harrel's c-statistics for model discrimination. Results: We included 2147 patients with AF on OAC (72.5% male, mean age 73.4 ± 8.2 years), of whom 1209 (56.3%) took DOACs. After a follow-up of 4.4 years, a total of 255 (11.9%) bleeding events occurred. After backward elimination, age > 75 years, history of cancer, prior major hemorrhage, and arterial hypertension remained in the final prediction model. The Brier score was 0.23 (95% confidence interval [CI] 0.19-0.27), the c-statistic at 12 months was 0.71 (95% CI 0.63-0.80). Conclusion: In this prospective cohort study of AF patients and predominantly DOAC users, we successfully derived a bleeding risk prediction model with good calibration and discrimination.

Keywords
  • SWISS-AF
  • Atrial fibrillation
  • Bleeding risk
  • Direct oral anticoagulants
  • Oral anticoagulants
  • Administration, Oral
  • Aged
  • Aged, 80 and over
  • Anticoagulants / adverse effects
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / drug therapy
  • Cohort Studies
  • Female
  • Hemorrhage / chemically induced
  • Hemorrhage / drug therapy
  • Hemorrhage / epidemiology
  • Humans
  • Male
  • Prospective Studies
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / epidemiology
  • Stroke / prevention & control
  • Switzerland
Citation (ISO format)
ADAM, Luise et al. Novel bleeding risk score for patients with atrial fibrillation on oral anticoagulants, including direct oral anticoagulants. In: Journal of thrombosis and haemostasis, 2021, vol. 19, n° 4, p. 931–940. doi: 10.1111/jth.15251
Main files (2)
Article (Accepted version)
Article (Published version)
Identifiers
Journal ISSN1538-7836
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37downloads

Technical informations

Creation21/02/2022 15:38:00
First validation21/02/2022 15:38:00
Update time16/03/2023 06:39:04
Status update16/03/2023 06:39:01
Last indexation01/11/2024 01:48:29
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