Relation of the HAS-BLED bleeding risk score to major bleeding, cardiovascular events, and mortality in anticoagulated patients with atrial fibrillation

Circulation: Arrhythmia and Electrophysiology

Volumn 5, Issue 2, 2012, Pages 312-318

  Gallego, Pilar ^a   Roldán, Vanessa ^a   Torregrosa, José Miguel ^a   Gálvez, Josefa ^a   Valdés, Mariano ^b   Vicente, Vicente ^a   Marín, Francisco ^b   Lip, Gregory Y H ^c  

^a HOSPITAL MORALES MESEGUER   (Spain)

^b HOSPITAL UNIVERSITARIO VIRGEN DE LA ARRIXACA   (Spain)

^c UNIVERSITY OF BIRMINGHAM   (United Kingdom)

Author keywords

Atrial fibrillation; Cardiovascular diseases; Hemorrhage; Mortality

Indexed keywords

ACUTE CORONARY SYNDROME; ACUTE HEART FAILURE; AGED; ALCOHOL CONSUMPTION; ANTICOAGULANT THERAPY; ARTICLE; BLEEDING; BRAIN HEMORRHAGE; FEMALE; FOLLOW UP; HAS BLED SCORE; HEART ATRIUM FIBRILLATION; HEART FAILURE; HUMAN; INTERNATIONAL NORMALIZED RATIO; MAJOR CLINICAL STUDY; MALE; MEDICAL HISTORY; MORTALITY; PREDICTIVE VALUE; PRIORITY JOURNAL; RATING SCALE; SCORING SYSTEM; SEX DIFFERENCE; STROKE; COHORT ANALYSIS; EVALUATION; INCIDENCE; METHODOLOGY; PROPORTIONAL HAZARDS MODEL; RETROSPECTIVE STUDY; RISK ASSESSMENT; RISK FACTOR; SURVIVAL RATE;

ANTICOAGULANT AGENT;

AGED; AGED, 80 AND OVER; ANTICOAGULANTS; ATRIAL FIBRILLATION; COHORT STUDIES; FEMALE; FOLLOW-UP STUDIES; HEART FAILURE; HEMORRHAGE; HUMANS; INCIDENCE; MALE; PREDICTIVE VALUE OF TESTS; PROPORTIONAL HAZARDS MODELS; RETROSPECTIVE STUDIES; RISK ASSESSMENT; RISK FACTORS; STROKE; SURVIVAL RATE;

EID: 84862256342     PISSN: 19413149     EISSN: 19413084     Source Type: Journal    
DOI: 10.1161/CIRCEP.111.967000     Document Type: Article

References (27)

1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22:983-988.
2. The Stroke Risk in Atrial Fibrillation Working Group. Independent predictors of stroke in patients with atrial fibrillation. A systematic review. Neurology. 2007;69:546-554.
3. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146:857-867.
4. Lip GY, Lim HS. Atrial fibrillation and stroke prevention. Lancet Neurol. 2007;6:981-993.
5. Poli D, Antonucci E, Marcucci R, Fatini C, Alterini B, Mannini L, Falciani M, Abbate R, Gensini GF, Prisco D. Risk of bleeding in very old atrial fibrillation patients on warfarin: relationship with ageing and CHADS2 score. Thromb Res. 2007;121:347-352.
6. Hylek EM, Evans-Molina C, Shea C, Henault LE, Regan S. Major hemorrhage and tolerability of warfarin in the first year of therapy among elderly patients with atrial fibrillation. Circulation. 2007;115:2689-2696.
7. Hughes M, Lip GYH. Risk factors for anticoagulation-related bleeding complications in patients with atrial fibrillation: a systematic review. QJM. 2007;100:599-607.
8. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31:2369-2429.
9. Cairns JA, Connolly S, McMurtry S, Stephenson M, Talajic M; CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter. Can J Cardiol. 2011;27:74-90.
10. Lip GYH, Andreotti F, Fauchier L, Huber K, Hylek E, Knight E, Lane D, Levi M, Marin F, Palareti G, Kirchhof P. Bleeding risk assessment and management in atrial fibrillation patients. Executive summary of a position document from the European Heart Rhythm Association [EHRA], endorsed by the European Society of Cardiology [ESC] Working Group on Thrombosis. Thromb Haemost. 2011;106:997-1011.
11. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010; 138:1093-1100.
12. Lip GY, Frison L, Halperin JL, Lane DA. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly, drugs/alcohol concomitantly) score. J Am Coll Cardiol. 2011;57: 173-180.
13. Schulman S, Kearon C; Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3:692-694.
14. Roldán V, Marín F, Muiña B, Torregrosa JM, Hernández-Romero D, Valdés M, Vicent V, Lip GY. Plasma von Willebrand factor levels are an independent risk factor for adverse events, including mortality and major bleeding in anticoagulated atrial fibrillation patients. J Am Coll Cardiol. 2011;57:2496-2504.
15. Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271:840-844.
16. Poli D, Antonucci E, Grifoni E, Abbate R, Gensini GF, Prisco D. Bleeding risk during oral anticoagulation in atrial fibrillation patients older than 80 years. J Am Coll Cardiol. 2009;54:999-1002.
17. Kuijer PM, Hutten BA, Prins MH, Büller HR. Prediction of the risk of bleeding during anticoagulant treatment for venous thromboembolism. Arch Intern Med. 1999;159:457-460.
18. Shireman TI, Howard PA, Kresowik TF, Ellerbeck EF. Combined anticoagulant-antiplatelet use and major bleeding events in elderly atrial fibrillation patients. Stroke. 2004;35:2362-2367.
19. Fang MC, Chang Y, Hylek EM, Rosand J, Greenberg SM, Go AS, Singer DE. Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med. 2004;141:745-752.
20. Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY, Murray E; BAFTA investigators; Midland Research Practices Network (MidReC). Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet. 2007;370:493-503.
21. van Walraven C, Hart RG, Connolly S, Austin PC, Mant J, Hobbs FD, Koudstaal PJ, Petersen P, Perez-Gomez F, Knottnerus JA, Boode B, Ezekowitz MD, Singer DE. Effect of age on stroke prevention therapy in patients with atrial fibrillation: the Atrial Fibrillation Investigators. Stroke. 2009;40:1410-1416.
22. Gage BF, Yan Y, Milligan PE, Waterman AD, Culverhouse R, Rich MW, Radford MJ. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006;151:713-719.
23. Pencina MJ, D'Agostino RB Sr, Larson MG, Massaro JM, Vasan RS. Predicting the 30-year risk of cardiovascular disease: the Framingham Heart Study. Circulation. 2009;119:3078-3084.
24. Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133:160S-198S.
25. Olesen JB, Lip GY, Lindhardsen J, Lane DA, Ahlehoff O, Hansen ML, Raunsø J, Tolstrup JS, Hansen PR, Gislason GH, Torp-Pedersen C. Risks of thromboembolism and bleeding with thromboprophylaxis in patients with atrial fibrillation: a net clinical benefit analysis using a 'real world' nationwide cohort study. Thromb Haemost. 2011;106:739-749.
26. García AD, Lopes RD, Hylek EM. New-onset atrial fibrillation and warfarin initiation: high risk periods and implications for new antithrombotic drugs. Thromb Haemost. 2010;104:1099-1105.
27. Wan Y, Heneghan C, Perera R, Roberts N, Hollowell J, Glasziou P, Bankhead C, Xu Y. Anticoagulation control and prediction of adverse events in patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes. 2008;1:84-91.