HAS-BLED Score In Patients Research Articles

Relation of red cell distribution width with HAS-BLED score in patients with non-valvular atrial fibrillation.

BackgroundNumerous researchers have shown that there is a close correlation between red cell distribution width (RDW) and cardiovascular disease such as heart failure, coronary heart disease, and atrial fibrillation. This study was designated to investigate the correlation between RDW and the Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs/alcohol (HAS-BLED) score.MethodsThe HAS-BLED scores of 251 hospitalized patients with non-valvular atrial fibrillation were calculated and the receiver operating characteristics were used to evaluate the predictive value of RDW on high HAS-BLED score (≥3 scores). Multiple logistic regression analysis was used to analyze the independent predictor of high HAS-BLED scores.ResultsCorrelation analysis between RDW and HAS-BLED scores showed the RDW was positively correlated with HAS-BLED score, with r=0.393 (P<0.0001). The RDW of the high HAS-BLED score group was higher than that of the no-high HAS-BLED score group. The area under the receiver operating characteristic curve of RDW was 0.796 (0.740–0.844, P<0.0001) to predict a high HAS-BLED score, and multiple logistic regression analysis showed that a high RDW value could be used as an independent predictor of high HAS-BLED.ConclusionsRDW value is associated with HAS-BLED value, and can be used as the independent predictive factor of high HAS-BLED scores.

Importance of HAS-Bled Score in Patients on Warfarin Therapy for Atrial Fibrillation

Importance of HAS-Bled Score in Patients on Warfarin Therapy for Atrial Fibrillation

Use of simplified HAS-BLED score in patients with atrial fibrillation receiving warfarin.

BackgroundOral anticoagulant drugs are proven to prevent thromboembolism in patients with atrial fibrillation (AF). To date, HAS‐BLED score is used to assess bleeding risk. This study was conducted to compare simplified HAS‐BLED (sHAS‐BLED) with conventional HAS‐BLED (cHAS‐BLED) scores.MethodsThis retrospective study recruited patients with AF receiving warfarin among July 2013 to December 2018 in Central Chest Institute of Thailand. The cHAS‐BLED score used the time in therapeutic range less than 70% as labile INR, whereas sHAS‐BLED score used SAMe‐TT2R2 score of 3 or more as a substitute for labile INR. A paired Student's t test was used to compare sHAS‐BLED and cHAS‐BLED. The Pearson's correlation was used to assess the correlation of sHAS‐BLED to cHAS‐BLED scores. The Bland‐Altman plot was used to confirm the agreement of individual sHAS‐BLED to cHAS‐BLED score.ResultsA total of 126 AF patients were enrolled. The average age, SAMe‐TT2R2 score, and cHAS‐BLED score were 70.52 ± 10.37 years, 3.53 ± 1.03, and 2.03 ± 0.95, respectively. The sHAS‐BLED score was not statistically significantly different compared with cHAS‐BLED score (P = .08). The sHAS‐BLED and cHAS‐BLED scores had a very strong correlation with a correlation coefficient of .86 (P < .01). The Bland‐Altman plot was performed to confirm the agreement of individual sHAS‐BLED to cHAS‐BLED scores.ConclusionsThe sHAS‐BLED was not statistically significantly different compared with cHAS‐BLED and can be used in clinical practice. However, larger clinical trial will be needed to prove whether sHAS‐BLED can predict bleeding risk in the future.

Assessment of the Modified-HAS-BLED and Nutrition Score in Predicting Death in Patients with Heart Failure with and without Atrial Fibrillation

Background: The HAS-BLED score is used clinically for bleeding risk stratification in atrial fibrillation (AF). Its usefulness in a population of patients with heart failure (HF) is unclear. Purpose: To investigate whether HAS-BLED and nutrition factors predicts death in a cohort of patients with HF with and without AF. Method: We enrolled 147 patients who were diagnosed as having incident HF during 2010–2012. End of follow-up was March 31, 2016. Levels of the HAS-BLED score (based on 9 possible points, with higher scores indicating higher risk), stratified by concomitant AF at baseline. Analyses took into account the competing risk of death. Main Outcomes and Measures: Death within 5 year after HF diagnosis. Results: In patients with HF, the risks of death were 32.7% (n = 48). At high HAS-BLED scores (more than 4), the absolute risk of death was high (for a score of 4, 35.7% vs 19.1% for patients without and with concomitant AF, respectively; P < .05). C-statistics indicate that the HAS-BLED score performed modestly in this HF population with and without AF (for death, 5-year C-statistics 0.60, respectively). Conclusions: Among patients with incident HF with or without AF, the HAS-BLED score was associated with risk of death. Predictive accuracy was modest, and the clinical utility of the HAS-BLED score in patients with HF remains to be determined.

Utility of the HAS-BLED Score in Risk Stratifying Patients on Dual Antiplatelet Therapy Post 12 Months After Drug-Eluting Stent Placement.

Current guidelines recommend continuation of dual anti-platelet therapy (DAPT) for 12 months after percutaneous coronary intervention (PCI). Recent studies have shown benefit in continuing DAPT beyond 12 months but at the risk of increase bleeding. To date, there has been little data on risk stratifying patients to determine who can continue DAPT beyond 12 months at minimal bleeding risk. All patients who underwent drug-eluting stent (DES) placement from January 1, 2013 to September 30, 2014 were reviewed. Patients who had follow-up for at least 12 months, placement of 2nd generation everolimus-coated DES, and were on DAPT for at least 12 months were included. Patients with a history of atrial fibrillation, follow-up time less than 12 months, or were on concurrent oral anticoagulation therapy were excluded. Five hundred thirty-one patients were analyzed as described above. Two hundred two patients included in our study with 7 patients in the bleeding cohort and 195 patients in no-bleed cohort. The HAS-BLED score in patients who had a bleeding episode vs. those who did not was 3.29 vs. 2.24 (P value of 0.0009). Although not statistically significant, patients who had a bleeding episode were more likely to have renal dysfunction, alcohol use, be on prasugrel, and be on 325mg of aspirin. The study shows that the HAS-BLED score can be of utility in risk stratifying patients in determining who can continue DAPT beyond 12 months. Furthermore, a HAS-BLED score of less than 2 may help guide extended DAPT beyond 12 months at minimal bleeding risk. © 2016 Wiley Periodicals, Inc.

Bleeding Risk Profile in Patients With Symptomatic Peripheral Artery Disease

Purpose: To assess the bleeding risk profile using the HAS-BLED score in patients with symptomatic peripheral artery disease (PAD). Methods: A post hoc analysis was performed using data from a series of 115 consecutive patients (mean age 72.4±11.4 years; 68 men) with symptomatic PAD undergoing endovascular revascularization. The endpoint of the study was to assess bleeding risk using the 9-point HAS-BLED score, which was previously validated in cohorts of patients with and without atrial fibrillation. For the purpose of this study, the low (0–1), intermediate (2), and high-risk (≥3) scores were stratified as low/intermediate risk (HAS-BLED <3) vs high risk (HAS-BLED ≥3). Results: The mean HAS-BLED score was 2.76±1.16; 64 (56%) patients had a HAS-BLED score ≥3.0. Patients with PAD Rutherford category 5/6 ischemia had an even higher mean HAS-BLED score (3.20±1.12). Logistic regression analysis revealed aortoiliac or femoropopliteal segment involvement, chronic kidney disease, as well as Rutherford category 5/6, to be independent risk factors associated with a HAS-BLED score ≥3. Conclusion: Patients with PAD, especially those presenting with Rutherford category 5/6 ischemic symptoms, have high HAS-BLED scores, suggesting increased risk for major bleeding. Prospective clinical validation of the HAS-BLED score in patients with PAD may help with the risk-benefit assessment when prescribing antithrombotic therapy.

New oral anticoagulants for the prevention of thromboembolic complications in atrial fibrillation: a single centre experience.

Prevention of thromboembolic complications is a priority in patients with atrial fibrillation (AF). Based on the current guidelines, the role of vitamin K antagonists (VKA) in stroke prevention has decreased in favour of novel oral anticoagulants (NOAC). To evaluate the proportion of AF patients who were prescribed a NOAC, compare populations of patients treated with VKA and NOAC, and identify factors predisposing to NOAC prescription at hospital discharge of AF patients. A single-centre prospective study was carried out based on medical records of 550 patients who were diagnosed with non-valvular AF and discharged from a Cardiology Department from September 2012 till August 2013. Among 550 patients with AF, an oral anticoagulant (OAC) was prescribed for stroke prevention in 463 (84.2%) patients. At discharge, VKA was prescribed in 373 patients (80.6% of those treated with OAC), and NOAC was prescribed in 90 patients (19.4% of those treated with OAC). Among patients receiving NOAC, dabigatran was prescribed to 41 (45.6%) patients and rivaroxaban was prescribed to 49 (54.4%) patients. The mean CHA2DS2VASc scores in patients treated with VKA and NOAC were 3.8 ± 1.7 and 4.1 ± 1.7, respectively (p = NS). The mean HASBLED score in patients treated with VKA and NOAC was 2.2 ± 1.0 and 2 ± 0.9, respectively (p = NS). Patients treated with NOAC were older than patients treated with VKA (mean age 74.7 ± 11.9 vs. 70.5 ± 10.8 years, p = 0.0005). In multivariate analysis, factors associated with an increased likelihood of NOAC prescription included a history of bleeding (odds ratio [OR] 3.43), hospitalisation due to AF (OR 2.82), age ≥ 80 years (OR 2.8), paroxysmal arrhythmia (OR 1.77), and living in a rural area (OR 1.77). A NOAC was used in one fifth of all hospitalised AF patients receiving anticoagulant treatment. The risk of thromboembolic and bleeding complications did not differ between AF patients treated with NOAC or VKA. Factors associated with an increased likelihood of NOAC prescription included a history of bleeding, age ≥ 80 years, paroxysmal arrhythmia, hospitalisation due to AF, and living in a rural area.

Reported underuse of risk scores in patients with acute coronary syndromes without persistent ST elevations in clinical practice: results of a survey of the ALKK study group

Sirs: Current guidelines of the European Society of Cardiology (ESC) for the management of patients with non ST elvation acute coronary syndrome (NSTE-ACS) recommend the use of risk scores for decision making [1]. These recommendations include risk scores for ischemic events such as the GRACE [2] and TIMI [3] risk scores and bleeding events such as the CRUSADE [4] and ACUITY [5] scores. Little is known about the implementation of these risk scores in clinical practice. Therefore, the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK) has performed a survey to determine the use and value of risk scores in German hospitals and to evaluate the clinical factors which are used for the selection of patients for an invasive strategy in NSTE-ACS. Response to the questionnaire has been received from 103 out of 210 hospitals (97 % with cardiac catheterization laboratory, all with 24/7 PCI service), 67 % with chest pain unit certified by the German Cardiac Society [6, 7], 58 % member of a regional myocardial infarction network). The use of ischemic risk scores is shown in Fig. 1. Even less used are risk scores for bleeding in patients with NSTE-ACS, while the HAS-Bled score in patients with atrial fibrillation shows a much more widespread use [8] (Fig. 2). The ESC NSTE-ACS guidelines list two primary and seven secondary criteria for an invasive management [1]. We asked the clinicians to rank these criteria from 1 to 9 in their value for the decision making, being 1 the most and 9 the least important factor. The table shows the results, with the GRACE risk score being only at the end of the list (Table 1). We furthermore asked for the percentage of patients undergoing an invasive strategy at different time points after admission. While 19 % of patients undergo coronary