Arrhythmias and Conduction DisturbancesComparison of HAS-BLED and HAS-BED Versus CHADS2 and CHA2DS2VASC Stroke and Bleeding Scores in Patients With Atrial Fibrillation
Section snippets
Methods
The START register is an observational, multicenter, prospective cohort study that includes adults (>18 years) who start anticoagulation therapy, whatever the clinical indication for the therapy, the drug and dosage used.7 The aim of the START register is to collect data on effectiveness and safety of anticoagulant treatments, on determinants of adverse events in anticoagulated patients, as well as on their quality of life and compliance to treatment. The register has been approved on October
Results
We followed an inception cohort of 4,579 patients with AF starting anticoagulation and enrolled in the START register, patients characteristics are listed in Table 1. The distribution of patients according to stroke and bleeding risk scores is reported in Table 2. During follow-up, 115 patients experienced a MB events (rate 1.6 × 100 pt-yrs), and 13 hemorrhages (11.3%, rate 0.2 × 100 pt-yrs) were fatal. The distribution of MBs in relation to the considered scores is reported in Table 3 (as
Discussion
Our study confirms that HAS-BLED score is useful to identify patients at high risk for bleeding,11 even when HAS-BED is applied in naïve patients. In addition, the stroke predictive models CHADS2 and CHA2DS2-VASc scores are able to identify patients at high risk for bleeding, even if HAS-BLED and HAS-BED scores perform better for that purpose. However, as expected, the predictive ability for bleeding risk is modest for all the scores and among naïve patients is similar for both bleeding and
Disclosures
The authors have no conflicts of interest to disclose.
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2019, Critical Reviews in Oncology/HematologyCitation Excerpt :Direct oral anticoagulant is preferred choice over vitamin K antagonists if a patient requires anti-coagulant based on risk of stroke according to CHA2DS2-VASc score and bleeding according to the HAS-BLED score (Vrontikis et al., 2016; Kirchhof et al., 2016). A personalized, risk-adapted approach should be taken in selecting an anticoagulant: these are HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio) for patients receiving warfarin or HAS-BED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, elderly, drugs/alcohol) for treatment naive patients (Poli et al., 2017; Lip and Lane, 2016; Lip, 2012). Factor Xa inhibitors may be the preferred choice for anticoagulation in the elderly patients with multiple comorbidities.
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