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Evaluation of the predictive performance of bleeding risk scores in patients with non‐valvular atrial fibrillation on oral anticoagulants.

Summary: What is known and objective: Bleeding risk scores (BRSs) aid in the assessment of oral anticoagulant‐related bleeding risk in patients with atrial fibrillation. Ideally, the applicability of a BRS needs to be assessed, prior to its routine use in a population other than the original derivat...

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Published in:Journal of Clinical Pharmacy & Therapeutics Vol. 43; no. 2; pp. 209 - 220
Main Authors: Beshir, S. A., Aziz, Z., Yap, L. B., Chee, K. H., Lo, Y. L.
Format: research tables/charts Journal Article
Published: Wiley-Blackwell Apr2018
Online Access:View this record in EBSCOhost
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        02694727
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      jtl: Journal of Clinical Pharmacy & Therapeutics
      issn: 02694727
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      dt: Apr2018
      vid: 43
      iid: 2
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      pub: Wiley-Blackwell
      place: Malden, Massachusetts
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        128258160
        128258160
        128258160
        10.1111/jcpt.12634
        128258160
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        atl: Evaluation of the predictive performance of bleeding risk scores in patients with non‐valvular atrial fibrillation on oral anticoagulants.
      aug:
        au:
          Beshir, S. A.
          Aziz, Z.
          Yap, L. B.
          Chee, K. H.
          Lo, Y. L.
        affil: Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
      sug:
        subj:
          Hemorrhage Risk Factors
          Atrial Fibrillation Drug Therapy
          Anticoagulants Therapeutic Use
          Anticoagulants Adverse Effects
          Anticoagulants Administration and Dosage
          Administration, Oral
          Instrument Validation
          Human
          Malaysia
          Medical Records
          Scales
          Tertiary Health Care
          Multiple Logistic Regression
          Multivariate Analysis
          Aged
          Aged, 80 and Over
          Male
          Gastrointestinal Hemorrhage Risk Factors
          Confidence Intervals
          Rivaroxaban Administration and Dosage
          Rivaroxaban Adverse Effects
          Dabigatran Etexilate Adverse Effects
          Warfarin Adverse Effects
          Warfarin Therapeutic Use
          Dabigatran Etexilate Therapeutic Use
          Rivaroxaban Therapeutic Use
          Warfarin Administration and Dosage
          Dabigatran Etexilate Administration and Dosage
          Aged: 65+ years
          Aged, 80 & over
          Male
      ab: Summary: What is known and objective: Bleeding risk scores (BRSs) aid in the assessment of oral anticoagulant‐related bleeding risk in patients with atrial fibrillation. Ideally, the applicability of a BRS needs to be assessed, prior to its routine use in a population other than the original derivation cohort. Therefore, we evaluated the performance of 6 established BRSs to predict major or clinically relevant bleeding (CRB) events associated with the use of oral anticoagulant (OAC) among Malaysian patients. Methods: The pharmacy supply database and the medical records of patients with non‐valvular atrial fibrillation (NVAF) receiving warfarin, dabigatran or rivaroxaban at two tertiary hospitals were reviewed. Patients who experienced an OAC‐associated major or CRB event within 12 months of follow‐up, or who have received OAC therapy for at least 1 year, were identified. The BRSs were fitted separately into patient data. The discrimination and the calibration of these BRSs as well as the factors associated with bleeding events were then assessed. Results: A total of 1017 patients with at least 1‐year follow‐up period, or those who developed a bleeding event within 1 year of OAC use, were recruited. Of which, 23 patients experienced a first major bleeding event, whereas 76 patients, a first CRB event. Multivariate logistic regression results show that age of 75 or older, prior bleeding and male gender are associated with major bleeding events. On the other hand, prior gastrointestinal bleeding, a haematocrit value of less than 30% and renal impairment are independent predictors of CRB events. All the BRSs show a satisfactory calibration for major and CRB events. Among these BRSs, only HEMORR2HAGES (<italic>C</italic>‐statistic = 0.71, 95% CI 0.60‐0.82, <italic>P </italic><<italic> </italic>.001) and ATRIA score (<italic>C</italic>‐statistic = 0.70, 95% CI 0.58‐0.82, <italic>P </italic><<italic> </italic>.001) show acceptable discrimination performance for major bleeding events. All the 6 BRSs, however, lack acceptable predictive performance for CRB events. What is new and conclusion: To the best of our knowledge, this is the first evaluation study of the predictive performance of these 6 BRSs on clinically relevant bleeding events applied to the same cohort consisting of mainly Asian novel oral anticoagulant users. These BRSs show poor to acceptable predictive performance on OAC‐induced major or CRB events. An improvement in the existing BRSs for OAC users is warranted.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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