BIRMINGHAM, UNITED KINGDOM. A new scheme, HAS-BLED, was recently developed as a means of predicting bleeding risks in atrial fibrillation (AF) patients receiving antithrombotic treatment. Now a team of researchers from England, Sweden and the United States reports their evaluation of the validity of the scheme in a group of 7,329 AF patients at moderate to high risk of stroke who were anticoagulated with warfarin (3,665 patients) or ximelagatran (no longer available). They compared the HAS-BLED scheme to four other less well known schemes and found HAS-BLED to be superior.
In looking at the actual risk factors in the overall group (warfarin and ximelagatran), they found (in multivariate analysis) that the following factors were independent predictors of an increased risk of bleeding when being anticoagulated.
- Concomitant aspirin use – increased bleeding risk by 92%
- Kidney dysfunction – increased bleeding risk by 90%
- Age 75 years or greater – increased bleeding risk by 71%
- Diabetes – increased bleeding risk by 36%
- Left ventricular dysfunction – increased bleeding risk by 31%
Applying the HAS-BLED scoring system to the whole patient group resulted in the following annual risk (%/year) of suffering a major bleed when on warfarin or ximelagatran.