Abstract
Objective: Despite extensive use of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) and the increased bleeding risk associated with such OAC use, no handy quantification tool for assessing this risk exists. We aimed to develop a practical risk score to estimate the 1-year risk for major bleeding (intracranial, hospitalization, hemoglobin decrease >2 g/L, and/or transfusion) in a cohort of real-world patients with AF. Methods: Based on 3,978 patients in the Euro Heart Survey on AF with complete follow-up, all univariate bleeding risk factors in this cohort were used in a multivariate analysis along with historical bleeding risk factors. A new bleeding risk score termed HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 65 years), Drugs/alcohol concomitantly) was calculated, incorporating risk factors from the derivation cohort. Results: Fifty-three (1.5%) major bleeds occurred during 1-year follow-up. The annual bleeding rate increased with increasing risk factors. The predictive accuracy in the overall population using significant risk factors in the derivation cohort (C statistic 0.72) was consistent when applied in several subgroups. Application of the new bleeding risk score (HAS-BLED) gave similar C statistics except where patients were receiving antiplatelet agents alone or no antithrombotic therapy, with C statistics of 0.91 and 0.85, respectively. Conclusion: This simple, novel bleeding risk score (HAS-BLED) provides a practical tool to assess the individual bleeding risk of real-world patients with AF, potentially supporting clinical decision making regarding antithrombotic therapy in patients with AF.
| Original language | English |
|---|---|
| Pages (from-to) | 1093-1100 |
| Number of pages | 8 |
| Journal | Chest |
| Volume | 138 |
| Issue number | 5 |
| DOIs | |
| State | Published - 1 Nov 2010 |
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In: Chest, Vol. 138, No. 5, 01.11.2010, p. 1093-1100.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation
T2 - The euro heart survey
AU - Pisters, Ron
AU - Lane, Deirdre A.
AU - Nieuwlaat, Robby
AU - De Vos, Cees B.
AU - Crijns, Harry J.G.M.
AU - Lip, Gregory Y.H.
AU - Andresen, Dieter
AU - Camm, A. John
AU - Davies, Wynn
AU - Capucci, Alessandro
AU - Le´vy, Samuel
AU - Olsson, Bertil
AU - Aliot, Etienne
AU - Breithardt, Gu¨nter
AU - Cobbe, Stuart
AU - Le Heuzey, Jean Yves
AU - Santini, Massimo
AU - Vardas, Panos
AU - Manini, Malika
AU - Bramley, Claire
AU - Laforest, Vale´rie
AU - Taylor, Charles
AU - Del Gaiso, Susan
AU - Huber, Kurt
AU - De Backer, Guy
AU - Sirakova, Vera
AU - Cerbak, Roman
AU - Thayssen, Per
AU - Lehto, Seppo
AU - Blanc, Jean Jacques
AU - Delahaye, Franc¸ois
AU - Kobulia, Bondo
AU - Zeymer, Uwe
AU - Cokkinos, Dennis
AU - Karlocai, Kristof
AU - Graham, Ian
AU - Shelley, Emer
AU - Behar, Shlomo
AU - Maggioni, Aldo
AU - Gonc¸alves, Lino
AU - Grabauskiene, Virginija
AU - Asmussen, Inger
AU - Deckers, Jaap
AU - Stepinska, Janina
AU - Mareev, Vyacheslav
AU - Vasiljevic, Zorana
AU - Riecansky, Igor
AU - Kenda, Miran F.
AU - Alonso, Angeles
AU - Lopez-Sendon, Jose´ Luis
AU - Rosengren, Annika
AU - Buser, Peter
AU - Okay, Tugrul
AU - Sychov, Oleg
AU - Fox, Kevin
AU - Schofield, Peter
AU - Simoons, Maarten
AU - Wood, David
AU - Battler, Alex
AU - Boersma, Eric
AU - Fox, Kim
AU - Komajda, Michel
AU - McGregor, Keith
AU - Mulder, Barbara
AU - Priori, Sylvia
AU - Ryde´n, Lars
AU - Vahanian, Alec
AU - Wijns, William
AU - Sanofi-Aventis,
AU - Grigoryan, S. V.
AU - Apetyan, I.
AU - Aroyan, S.
AU - Azarapetyan, L.
AU - Anvari, Anahit
AU - Gottsauner-Wolf, Michael
AU - Pfaffenberger, Stefan
AU - Aydinkoc, Kadriye
AU - Kalla, Karim
AU - Penka, Martina
AU - Drexel, Heinz
AU - Langer, Peter
AU - Pierard, Luc A.
AU - Legrand, Victor
AU - Blommaert, Dominique
AU - Schroeder, E.
AU - Mancini, Isabelle
AU - Geelen, P.
AU - Brugada, P.
AU - De Zutter, Marc
AU - Vrints, Christiaan
AU - Vercammen, Marc
AU - Morissens, Marielle
AU - Borisov, Boyanov
AU - Petrov, Valentin Asenov
AU - Marinova, Maria
AU - Assen, Alexandrova
AU - Goudev, Rachev
AU - Peychev, Yavor
AU - Stoyanovsky, Vassil
AU - Stoynev, Evgeni
AU - Kranjcevic, Stjepan
AU - Moutiris, Joseph
AU - Ioannides, Marios
AU - Evequoz, Dominique
AU - Spacilova, Jaroslava
AU - Novak, Miroslav
AU - Eisenberger, Martin
AU - Mullerova, Jolana
AU - Kautzner, Josef
AU - Riedlbauchova, Lucie
AU - Petru`, Jan
AU - Taborsky, Milos
AU - Cappelen, Helle
AU - Sharaf, Yasser A.
AU - Ibrahim, B. S.S.
AU - Tammam, Khalid
AU - Saad, Aly
AU - Elghawaby, Helmy
AU - Sherif, Hamed Zaky
AU - Farouk, Heba
AU - Mielke, Arlett
AU - Engelen, Markus
AU - Kirchhof, Paulus
AU - Zimmermann, Pia
AU - Aviles, F. Fernandez
AU - Rubio, Jeronimo
AU - Malpartida, F.
AU - Corona, M.
AU - Sanchez, Luis Tercedor
AU - Miguel, Jose
AU - Herrera, Lozano
AU - Quesada, Aurelio
AU - Garcia, Antonio J.Munoz
AU - Gonzalez, Carlos Sanchez
AU - Juango, M. Soledad Alcasena
AU - Berjon-Reyero, Jesus
AU - Alegret, Josep M.
AU - Fernandez, J. M.Cruz
AU - Carrascosa, Cesar
AU - Romero, Rosillo Antonio Fernandez
AU - Lara, Miguel Gonza´lez
AU - Sendon, Jose´ L.Lopez
AU - de Diego, Jose´ Juan Gomez
AU - Martin, Luis Sosa
AU - Irurita, Maria
AU - Guttierez, Norbero Herrera
AU - Rubio, Juan Ramon Siles
AU - Antorrena, Isabel
AU - Paves, Alicia Bautista
AU - Salvador, Antonio
AU - Orriach, Maria Dolores
AU - Garcia, A. Alonso
AU - Epelde, Francisco
AU - Martinez, Vicente Bertomeu
AU - Sanchez, Antonio Berruezo
AU - Galvez, Carlos Pinero
AU - Rivero, Rafael Fernandez
AU - Madrid, Antonio Hernandez
AU - Baron-Esquivias, Gonzalo
AU - Peinado, Rafael
AU - Guindal, Jose´ Antonio Gomez
AU - Vera, Tomas Ripoll
AU - Fernandez, Emilio Luengo
AU - Gayan, Ricardo
AU - Garcia, Javier
AU - Bodegas, Andres
AU - Lopez, Jesus Toril
AU - Florez, Julio Martinez
AU - Cabezas, Cristobal Lozano
AU - de Castroviejo, Eduardo Vazquez Ruiz
AU - Bellido, Juan Munoz
AU - Ruiz, Maria Eugenia
AU - Savolainen, Kirsti
AU - Nieminen, Markku
AU - Toivonen, Lauri
AU - Syvanne, Mikko
AU - Pietila, Mervi
AU - Galley, Daniel
AU - Beltra, Christine
AU - Gay, Alain
AU - Daubert, J. C.
AU - Lecocq, Guillaume
AU - Poulain, Christine
AU - Cleland, J. G.F.C.
AU - Shelton, Rhidian
AU - Choudhury, A.
AU - Abuladze, Gulnara
AU - Jashi, Irina
AU - Tsiavou, Anastasia
AU - Giamouzis, G.
AU - Dagres, N.
AU - Kostopoulou, A.
AU - Tsoutsanis, Domproglou
AU - Stefanadis, C.
AU - Latsios, George
AU - Vogiatzis, Ioannis
AU - Gotsis, Alexandros
AU - Bozia, Paraskevi
AU - Karakiriou, Maria
AU - Koulouris, Spyridon
AU - Parissis, John
AU - Kostakis, George
AU - Kouris, Nikos
AU - Kontogianni, Dimitra
AU - Athanasios, Koutroubas
AU - Douras, Alexandros
AU - Tsanakis, Themistoklis
AU - Marketou, Mary
AU - Patsourakos, Nikolaos
AU - Czopf, Laszlo
AU - Halmosi, Robert
AU - Pre´da, Istvan
AU - Csoti, Eva
AU - Badics, Andrea
AU - Strasberg, Boris
AU - Freedberg, Nahum A.
AU - Katz, Amos
AU - Zalzstein, Eli
AU - Grosbard, Aviva
AU - Goldhammer, E.
AU - Nahir, Menachem
AU - Epstein, Menashe
AU - Vider, Ida
AU - Luria, David
AU - Mandelzweig, Lori
AU - Aloisi, Bruno
AU - Cavallaro, Alfio
AU - Antonielli, Emanuele
AU - Doronzo, Baldassarre
AU - Pancaldo, Diego
AU - Mazzola, Carlo
AU - Buontempi, Liliana
AU - Calvi, Valeria
AU - Giuffrida, Giuseppe
AU - Figlia, Antonino
AU - Ippolito, Francesco
AU - Gelmini, Gian Paolo
AU - Gaibazzi, N.
AU - Ziacchi, Virgilio
AU - De Tommasi, Francesco
AU - Lombardi, Federico
AU - Fiorentini, Cesare
AU - Terranova, Paolo
AU - Maiolino, Pietro
AU - Albunni, Muhamad
AU - Pinna-Pintor, Plinio
AU - Fumagalli, Stefano
AU - Masotti, Guilio
AU - Boncinelli, Lorenzo
AU - Rossi, Domenico
AU - Santoro, Giovanni Maria
AU - Fioranelli, Massimo
AU - Naccarella, Franco
AU - Maranga, Stefano Sdringola
AU - Lepera, Giovannina
AU - Bresciani, Barbara
AU - Seragnoli, Elena
AU - Forti, Mara Cantelli
AU - Cortina, Valentina
AU - Baciarello, Giacinto
AU - Cicconetti, Paolo
AU - Lax, Antonio
AU - Vitali, Federica
AU - Igidbashian, Diran
AU - Scarpino, Luisa
AU - Terrazzino, Sergio
AU - Tavazzi, Luigi
AU - Cantu, Francesco
AU - Pentimalli, Francesco
AU - Novo, Salvatore
AU - Coppola, Giuseppe
AU - Zingarini, Gianluca
AU - Ambrozio, Giuseppe
AU - Moruzzi, Paolo
AU - Callegari, Sergio
AU - Saccomanno, Gabriele
AU - Russo, Paolo
AU - Carbonieri, Emanuele
AU - Paino, Anna
AU - Zanetta, Marco
AU - Barducci, Enzo
AU - Cemin, Roberto
AU - Rauhe, Werner
AU - Pitscheider, Walter
AU - Meloni, Marina
AU - Marchi, Sergio Mariano
AU - Di Gennaro, Marco
AU - Calcagno, Sergio
AU - Squaratti, Paola
AU - Quartili, Francesco
AU - Bertocchi, Patrizia
AU - De Martini, Mario
AU - Mantovani, Giuseppe
AU - Komorovsky, Roman
AU - Desideri, Alessandro
AU - Celegon, Leopoldo
AU - Tarantini, Luigi
AU - Catania, Giuseppe
AU - Lucci, Donata
AU - Bianchini, Francesca
AU - Puodziukynas, Aras
AU - Kavoliuniene, Ausra
AU - Barauskiene, Vilija
AU - Aidietis, Audrius
AU - Barysiene, Jurate
AU - Vysniauskas, Vitas
AU - Zukauskiene, Irena
AU - Kazakeviciene, Nijole
AU - Georgievska-Ismail, Ljubica
AU - Poposka, Lidija
AU - Vataman, Eleonora
AU - Grosu, Aurel A.
AU - op Reimer, Wilma Scholte
AU - de Swart, Esther
AU - Lenzen, Mattie
AU - Jansen, Chris
AU - Brons, Ritzo
AU - Tebbe, Henriette
AU - van Hoogenhuyze, D. C.A.
AU - Veerhoek, M. J.
AU - Kamps, Maria
AU - Haan, D.
AU - van Rijn, Nitolanda
AU - Bootsma, Annette
AU - Baur, Leo
AU - van den, Adrie
AU - Fransen, Heidi
AU - Eurlings, Luc
AU - Meeder, Joan
AU - De Boer, M. J.
AU - Winter, Jobst
AU - Broers, Herman
AU - Werter, Chris
AU - Bijl, M.
AU - Versluis, Saskia
AU - Milkowska, Malgorzata
AU - Wozakowska-Kaplon, Beata
AU - Janion, Marianna
AU - Lepska, Lidia
AU - Swiatecka, Grazyna
AU - Kokowicz, Piotr
AU - Cybulski, Jacek
AU - Gorecki, Aleksandr
AU - Szulc, Marcin
AU - Rekosz, Jerzy
AU - Manczak, Rafal
AU - Wnuk-Wojnar, Anna Maria
AU - Trusz-Gluza, M.
AU - Rybicka-Musialik, Anna
AU - Myszor, Jaroslaw
AU - Szpajer, Michal
AU - Cymerman, Krzysztof
AU - Sadowski, Jerzy
AU - Sniezek-Maciejewska, Maria
AU - Ciesla-Dul, Mariola
AU - Gorkiewicz-Kot, Izabela
AU - Grodzicki, Tomasz
AU - Rewiuk, Krzysztof
AU - Kubik, Leszek
AU - Lewit, Jacek
AU - de Sousa, Joao Manuel Frazao Rodrigues
AU - Ferreira, Rafael
AU - Freitas, Antonio
AU - Morais, Joao Carlos Araujo
AU - Pires, Rui
AU - Gomes, M. J.Veloso
AU - Gago, Paula
AU - Candeias, Rui Alexandre C.
AU - Nunes, Luis
AU - Sa, Joao Vitor Miranda
AU - Ventura, Miguel
AU - de Oliveira, Mario
AU - Alves, Luis Brandao
AU - Bostaca, Ioan
AU - Olariu, Codin T.
AU - Dan, G. A.
AU - Dan, Anca
AU - Podoleanu, Cristian
AU - Frigy, Attila
AU - Georgescu, George I.M.
AU - Arsenescu, Catalina
AU - Statescu, Cristian
AU - Sascau, Radu
AU - Dimitrascu, Dan L.
AU - Rancea, Raluca
AU - Shubik, Yuri V.
AU - Duplyakov, Dmitry
AU - Shalak, Marina
AU - Danielyan, Marine
AU - Galyavich, Albert
AU - Zakirova, Venera
AU - Hatala, Robert
AU - Kaliska, Gabriela
AU - Kmec, Jan
AU - Zupan, Igor
AU - Tasie`, Jerneja
AU - Vokac, Damijan
AU - Edvardsson, Nils
AU - Poci, Dritan
AU - Gamra, Habib
AU - Denguir, Hichem
AU - Sepetoglu, Ahmet
AU - Arat-Ozkan, Alev
AU - Orynchak, Mariya
AU - Paliy, Elena
AU - Vakalyuk, I.
AU - Malidze, David
AU - Prog, Rostyslav
AU - Yabluchansky, Myckola Ivanovich
AU - Makienko, Nataliya Volodimirovna
AU - Potpara, Tatjana
AU - Knezevic, Sofija
AU - Randjelovic, Miomir
N1 - Funding Information: Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Pisters has consulting fees from Bayer and Boehringel Ingelheim and lecture fees from Boehringer Ingelheim. Dr Lane is the recipient of an investigator-initiated educational grant from Bayer Healthcare and has received sponsorship to attend the European Society of Cardiology Congress 2009 from AstraZeneca. Dr Crijn has received consulting fees from Boehringer Ingelheim, Sanofi-Aventis, and AstraZeneca; grant support from St. Jude Medical, Boston Scientific, Boehringer Ingelheim, Sanofi-Aventis, Medapharma, and Merck; and honoraria from Medtronic, Sanofi-Aventis, Medapharma, Merck, Boehringer Ingelheim, and Biosense Webster. Dr Lip has served as a consultant for Bayer, Astellas, Merck, AstraZeneca, Sanofi-Aventis, Aryx, Portola, Biotronic, and Boehringher Ingelheim, and has been on the speakers bureau for Bayer, Boehringher Ingelheim, and Sanofi-Aventis. Drs Nieuwlaat and de Vos have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
PY - 2010/11/1
Y1 - 2010/11/1
N2 - Objective: Despite extensive use of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) and the increased bleeding risk associated with such OAC use, no handy quantification tool for assessing this risk exists. We aimed to develop a practical risk score to estimate the 1-year risk for major bleeding (intracranial, hospitalization, hemoglobin decrease >2 g/L, and/or transfusion) in a cohort of real-world patients with AF. Methods: Based on 3,978 patients in the Euro Heart Survey on AF with complete follow-up, all univariate bleeding risk factors in this cohort were used in a multivariate analysis along with historical bleeding risk factors. A new bleeding risk score termed HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 65 years), Drugs/alcohol concomitantly) was calculated, incorporating risk factors from the derivation cohort. Results: Fifty-three (1.5%) major bleeds occurred during 1-year follow-up. The annual bleeding rate increased with increasing risk factors. The predictive accuracy in the overall population using significant risk factors in the derivation cohort (C statistic 0.72) was consistent when applied in several subgroups. Application of the new bleeding risk score (HAS-BLED) gave similar C statistics except where patients were receiving antiplatelet agents alone or no antithrombotic therapy, with C statistics of 0.91 and 0.85, respectively. Conclusion: This simple, novel bleeding risk score (HAS-BLED) provides a practical tool to assess the individual bleeding risk of real-world patients with AF, potentially supporting clinical decision making regarding antithrombotic therapy in patients with AF.
AB - Objective: Despite extensive use of oral anticoagulation (OAC) in patients with atrial fibrillation (AF) and the increased bleeding risk associated with such OAC use, no handy quantification tool for assessing this risk exists. We aimed to develop a practical risk score to estimate the 1-year risk for major bleeding (intracranial, hospitalization, hemoglobin decrease >2 g/L, and/or transfusion) in a cohort of real-world patients with AF. Methods: Based on 3,978 patients in the Euro Heart Survey on AF with complete follow-up, all univariate bleeding risk factors in this cohort were used in a multivariate analysis along with historical bleeding risk factors. A new bleeding risk score termed HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 65 years), Drugs/alcohol concomitantly) was calculated, incorporating risk factors from the derivation cohort. Results: Fifty-three (1.5%) major bleeds occurred during 1-year follow-up. The annual bleeding rate increased with increasing risk factors. The predictive accuracy in the overall population using significant risk factors in the derivation cohort (C statistic 0.72) was consistent when applied in several subgroups. Application of the new bleeding risk score (HAS-BLED) gave similar C statistics except where patients were receiving antiplatelet agents alone or no antithrombotic therapy, with C statistics of 0.91 and 0.85, respectively. Conclusion: This simple, novel bleeding risk score (HAS-BLED) provides a practical tool to assess the individual bleeding risk of real-world patients with AF, potentially supporting clinical decision making regarding antithrombotic therapy in patients with AF.
UR - http://www.scopus.com/inward/record.url?scp=77955872745&partnerID=8YFLogxK
U2 - 10.1378/chest.10-0134
DO - 10.1378/chest.10-0134
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
AN - SCOPUS:77955872745
SN - 0012-3692
VL - 138
SP - 1093
EP - 1100
JO - Chest
JF - Chest
IS - 5
ER -