Low performance of bleeding risk models in the very elderly with atrial fibrillation using vitamin K antagonists

Journal of Thrombosis and Haemostasis

Volumn 14, Issue 9, 2016, Pages 1715-1724

  Jaspers Focks, J ^a,b   van Vugt, S P G ^a,b   Albers Akkers, M T H ^b   Lamfers, E J P ^c   Bloem de Vries, L M ^b   Verheugt, F W A ^a   Brouwer, M A ^a  

^a RADBOUD UNIVERSITY MEDICAL CENTER   (Netherlands)

^b INR Trombosedienst Outpatient Anticoagulation Clinic Nijmegen   (Netherlands)

^c CANISIUS WILHELMINA HOSPITAL   (Netherlands)

Author keywords

atrial fibrillation; hemorrhage; registries; risk assessment; stroke; vitamin K antagonists

Indexed keywords

ACENOCOUMAROL; ANTICOAGULANT AGENT; ANTITHROMBOCYTIC AGENT; ANTIVITAMIN K; NONSTEROID ANTIINFLAMMATORY AGENT;

AGED; ANEMIA; ANTICOAGULATION; ARTICLE; ATRIA SCORE; ATRIAL FIBRILLATION; BLEEDING; COHORT ANALYSIS; CONTROLLED STUDY; DRUG SUBSTITUTION; DRUG WITHDRAWAL; FEMALE; FOLLOW UP; GERIATRIC PATIENT; HAS-BLED SCORE; HEMORR2HAGES SCORE; HUMAN; INTERMETHOD COMPARISON; LOW RISK PATIENT; MAJOR CLINICAL STUDY; MALE; PATIENT CODING; POLYPHARMACY; POPULATION RESEARCH; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL; RISK ASSESSMENT; RISK BENEFIT ANALYSIS; RISK FACTOR; SCORING SYSTEM; THROMBOCYTOPENIA; VERY ELDERLY;

EID: 84988452162     PISSN: 15387933     EISSN: 15387836     Source Type: Journal    
DOI: 10.1111/jth.13361     Document Type: Article

References (38)

1. Torn M, Bollen WLEM, van der Meer FJM, van der Wall EE, Rosendaal FR. Risks of oral anticoagulation therapy with increasing age. Arch Intern Med 2005; 165: 1527–32.
2. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have non-valvular atrial fibrillation. Ann Intern Med 2007; 146: 857–67.
3. Mant J, Hobbs R, Fletcher K, Roalfe A, Fitzmaurice D, Lip GYH; BAFTA Investigators. 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.
4. Scowcroft AC, Lee S, Mant J. Thromboprophylaxis of elderly patients with AF in the UK: an analysis using the General Practice Research Database (GPRD) 2000–2009. Heart 2013; 99: 127–32.
5. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 385: 117–71.
6. Thomas IC, Sorrentino MJ. Bleeding risk prediction models in atrial fibrillation. Curr Cardiol Rep 2014; 16: 432–9.
7. 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: 1093–100.
8. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CQ; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014; 64: 2305–7.
9. Camm AJ, Lip GY, de Caterina R, Savelieva I, Hohnloser SH, Hindricks G, Kirchhof P; ESC Committee for Practice Guidelines (CPG). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012; 33: 2719–47.
10. Fang MC, Go AS, Chang Y, Borowsky LH, Pomernacki NK, Udaltsova N, Singer DE. A new risk scheme to predict warfarin-associated hemorrhage. J Am Coll Cardiol 2011; 58: 395–401.
11. 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: 713–9.
12. Olesen JB, Lip GYH, Hansen PR, Lindhardsen J, Ahlehoff O, Andersson C, Weeke P, Hansen ML, Gislason GH, Torp-Pedersen C. Bleeding risk in ‘real world’ patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort. J Thromb Haemost 2011; 9: 1460–7.
13. Lip GYH, Frison L, Halperin JL, Lane DA. 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: 173–80.
14. Friberg L, Rosenqvist M, Lip GYH. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J 2012; 33: 1500–10.
15. Gallego P, Roldán V, Torregrosa JM, Gálvez J, Valdés M, Vicente V, Marín F, Lip GYH. Relation of the HAS-BLED bleeding risk score to predict major bleeding, cardiovascular events, and mortality in anticoagulated patients with atrial fibrillation. Circ Arrhythm Electrophysiol 2012; 5: 312–8.
16. 2HAGES, ATRIA, and HAS-BLED bleeding risk-prediction scores in patients with atrial fibrillation undergoing anticoagulation. J Am Coll Cardiol 2012; 60: 861–7.
17. Lip GYH, Banerjee A, Lagrenade I, Lane DA, Taillandier S, Fauchier L. Assessing the risk of bleeding in patients with atrial fibrillation. The Loire Valley atrial fibrillation project. Circ Arrhythm Electrophysiol 2012; 5: 941–8.
18. Burgess S, Crown N, Louzada ML, Dresser G, Kim RB, Lazo-Langner A. Clinical performance of bleeding risk scores for predicting major and clinically relevant non-major bleeding events in patients receiving warfarin. J Thromb Haemost 2013; 11: 1647–54.
19. Roldán V, Marín F, Fernández H, Manzano-Fernandez S, Gallego P, Valdés M, Vicente V, Lip GYH. Predictive value of the HAS-BLED and ATRIA bleeding risk scores for the risk of serious bleeding in a “real-world” population with atrial fibrillation receiving anticoagulation therapy. Chest 2013; 143: 179–84.
20. Rosendaal FR, Cannegieter SC, van der Meer FJ, Briet E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost 1993; 69: 236–9.
21. Schulman S, Kearon C; on behalf of the 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: 692–4.
22. Pencina MJ, D'Agostino RB, Vasan RS. Statistical methods for assessment of added usefulness of new biomarkers. Clin Chem Lab Med 2010; 48: 1703–11.
23. Soave C, Chidlovskii E, Lebelhomme A, Gaboreau Y, Pernod G, Bosson JL, Couturier P. Comparison of the HAS-BLED and ATRIA scores for the risk of bleeding in patients aged 75 and over receiving vitamin K antagonists (VKA) therapy and educated VKA-management. Geriatr Psychol Neuropsychiatr Vieil 2015; 13: 279–88.
24. Shireman TI, Mahnken JD, Howard PA, Kresowik TF, Hou Q, Ellerbeck EF. Development of a contemporary bleeding risk model for elderly warfarin recipients. Chest 2006; 130: 1390–6.
25. Abdelhafiz AH, Wheeldon NM. Risk factors for bleeding during anticoagulation of atrial fibrillation in older and younger patients in clinical practice. Am J Geriatr Pharmacother 2008; 6: 1–11.
26. Granziera S, Bertozza G, Pengo V, Marigo L, Denas G, Petruzzellis F, Rossi K, Infante T, Padayattil SJ, Perissinotto E, Manzato E, Nante G. To treat or not to treat very elderly naïve patients with atrial fibrillation with vitamin K antagonists (VKA): results from the VENPAF cohort. Intern Emerg Med 2015; 10: 795–804.
27. Hanon O, Assayag P, Belmin J, Collet JP, Emeriau JP, Fauchier L, Forette F, Friocourt P, Gentric A, Leclercq C, Komajda M, Le Heuzey JY; French Society of Geriatrics and Gerantology and French Society of Cardiology. Expert consensus of the French Society of Geriatrics and Gerontology on the management of atrial fibrillation in the elderly people. Arch Cardiovasc Dis 2013; 106: 303–23.
28. Lip GYH, Clementy N, Pericart L, Banerjee A, Fauchier L. Stroke and major bleeding risk in elderly patients aged 75 years with atrial fibrillation. The Loire Valley atrial fibrillation project. Stroke 2015; 46: 143–50.
29. Poli D, Antonucci E, Testa S, Tosetto A, Ageno W, Palareti G; for the Italian Federation of Anticoagulation Clinics (FCSA). Bleeding risk in very old patients on vitamin K antagonist treatment: results of a prospective collaborative study on elderly patients followed by Italian Centres for Anticoagulation. Circulation 2011; 124: 824–9.
30. Ruiz Ortiz M, Romo E, Mesa D, Delgado M, López Ibáñez C, Anguita M, Castillo JC, Arizón JM, Suárez de Lezo J. Outcomes and safety of antithrombotic treatment in patients aged 80 years or older with nonvalvular atrial fibrillation. Am J Cardiol 2011; 107: 1489–93.
31. 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: 2689–96.
32. Nieuwlaat R, Olsson SB, Lip GYH, Camm AJ, Breithardt G, Capucci A, Meeder JG, Prins MH, Lévy S, Crijns HJGM; on behalf of Euro Heart Survey Investigators. Guideline-adherent antithrombotic treatment is associated with improved outcomes compared with undertreatment in high-risk patients with atrial fibrillation. The Euro Heart Survey on Atrial Fibrillation. Am Heart J 2007; 153: 1006–12.
33. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, Serebruany V, Valgimigli M, Vranckx P, Taggart D, Sabik JF, Krucoff MW, Ohman EM, Steg PG, White H. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 2011; 123: 2736–47.
34. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–83.
35. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, Yasashita T, Antman EM. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014; 393: 955–62.
36. Verheugt FWA, Granger CB. Oral anticoagulants for stroke prevention in atrial fibrillation: current status, special situations, and unmet needs. Lancet 2015; 386: 303–10.
37. Hylek EM. Vitamin K antagonists and time in the therapeutic range: implications, challenges, and strategies for improvement. J Thromb Thrombolysis 2013; 35: 333–5.
38. Mearns ES, White CM, Kohn CG, Hawthorne J, Song JS, Meng J, Schein JR, Raut MK, Coleman CI. Quality of vitamin K antagonist control and outcomes in atrial fibrillation patients: a meta-analysis and meta-regression. Thromb J 2014; 12: 14.