Prediction of the Bleeding Events in Patients with Atrial Fibrillation

Abstract

Background: Thromboprophylaxis with oral anticoagulation is most effective in reducing stroke but is associated with similar rates of major bleeding in atrial fibrillation (AF) patients. Recently, the European Society of Cardiology provided a novel bleeding risk score named HAS-BLED. This purpose of this study was to validate the predictive value of HAS-BLED and degree of the activities-of-daily-life (ADL) in patients with AF. Methods and Results: From January 2009 to October 2009, 173 consecutive patients with documented AF by ECG at presentation to the emergency department were enrolled. The ADL were dichotomized (preserved or impaired) by the use of a Katz’ ADL scale (1963). During a mean follow-up period of 12 months, 41 (24%) patients experienced bleeding from any cause. There were no significant differences in the age, sex, prevalence of warfarin or antiplatelet use, or target therapeutic range of warfarin (60%) between the patients with and those without bleeding. The patients with bleeding had higher HAS-BLED scores (4.9±1.5 vs. 3.1±1.4, p=0.01) and more impaired ADL (63% vs. 37%, p=0.02) than those without bleeding. A logistic regression analysis revealed that prediction of bleeding events was improved when impaired ADL was considered with the HAS-BLED score (C-statistic: 0.752 vs. 0.786). Conclusion: Impaired ADL, in addition to the HAS-BLED score, was significantly predictive of bleeding in AF patients.