A-174 Comparison of Bleeding Risk Scales in Elderly Patients With Persistent Atrial Fibrillation

Abstract

Abstract Background Atrial fibrillation is a significant cause of thromboembolism and sudden death in the world making anticoagulant treatment a cornerstone; however, it is associated with bleeding risk. Currently, there are no studies in Ecuador that support the prognostic validity of the recent bleeding risk scales, as well as the lack of research to discover novel methods that are applicable and more accessible to use within the medical care setting.The Hemorr2hages, ORBIT and ATRIA scores represent a promising approach for those health centers that do not have INR available and consequently cannot measure risk through HASBLED (internationally recommended score). In this way, hemorrhagic events can be prevented in patients with atrial fibrillation with anticoagulant treatment without exception. Our main goal is to compare the predictive bleeding risk scores of 3 scales (Hemorr2hages, ORBIT, ATRIA) versus traditional HASBLED score. Methods In this retrospective cohort study, we assessed chronic persistent atrial fibrillation in 100 patients using the electronic medical records in an outpatient clinic in Guayaquil, Ecuador. We calculated 3 bleeding risk scores for each patient according to the variables measured in each one of them and used those to compare the categories against HASBLED’s. A Pearson correlation index was obtained, and ROC performance curves were made. P value <0.05 was deemed statistically significant. Results Of the 100 patients included, 65% were males, and mean age was 75±10.73. We reported only 6% bleeding events during the follow up. According to HASBLED score: 31% were at high risk. In comparison: 40% and 37% were also at high risk in Hemorr2hages and ATRIA scores, respectively. HASBLED was fairly correlated with Hemorr2hages and ATRIA scores (Pearson’s R: 0.617, p:<0.001; R:0.528, p:<0.001, respectively). Only 22% were classified at high risk by the ORBIT score. ROC curve analysis showed ORBIT’s AUC was 0.963, while Hemorr2hages, ATRIA and HASBLED were 0.931, 0.925, and 0.732 (p:<0.001), respectively. Conclusions In our sample, ORBIT score was better correlated with bleeding episodes than the other scales. This a promising approach for those health centers that do not count with INR reactive materials available for it to be measured at their laboratories. Further research is needed to accurately analyze whether criterion included in ORBIT score might predict bleeding scores better than HASBLED, Hemorr2hages and ORBIT tools; since the items required to calculate it are more readily accessible.