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Adam L, Feller M, Syrogiannouli L, Del-Giovane C, Donzé J, Baumgartner C, Segna D, Floriani C, Roten L, Fischer U, Aeschbacher S, Moschovitis G, Schläpfer J, Shah D, Amman P, Kobza R, Schwenkglenks M, Kühne M, Bonati LH, Beer J, Osswald S, Conen D, Aujesky D, Rodondi N. Novel bleeding risk score for patients with atrial fibrillation on oral anticoagulants, including direct oral anticoagulants. J Thromb Haemost 2021; 19:931-940. [PMID: 33501722 DOI: 10.1111/jth.15251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Balancing bleeding risk and stroke risk in patients with atrial fibrillation (AF) is a common challenge. Though several bleeding risk scores exist, most have not included patients on direct oral anticoagulants (DOACs). We aimed at developing a novel bleeding risk score for patients with AF on oral anticoagulants (OAC) including both vitamin K antagonists (VKA) and DOACs. METHODS We included patients with AF on OACs from a prospective multicenter cohort study in Switzerland (SWISS-AF). The outcome was time to first bleeding. Bleeding events were defined as major or clinically relevant non-major bleeding. We used backward elimination to identify bleeding risk variables. We derived the score using a point score system based on the β-coefficients from the multivariable model. We used the Brier score for model calibration (<0.25 indicating good calibration), and Harrel's c-statistics for model discrimination. RESULTS We included 2147 patients with AF on OAC (72.5% male, mean age 73.4 ± 8.2 years), of whom 1209 (56.3%) took DOACs. After a follow-up of 4.4 years, a total of 255 (11.9%) bleeding events occurred. After backward elimination, age > 75 years, history of cancer, prior major hemorrhage, and arterial hypertension remained in the final prediction model. The Brier score was 0.23 (95% confidence interval [CI] 0.19-0.27), the c-statistic at 12 months was 0.71 (95% CI 0.63-0.80). CONCLUSION In this prospective cohort study of AF patients and predominantly DOAC users, we successfully derived a bleeding risk prediction model with good calibration and discrimination.
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Affiliation(s)
- Luise Adam
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Feller
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM, University of Bern, Bern, Switzerland
| | | | - Cinzia Del-Giovane
- Institute of Primary Health Care (BIHAM, University of Bern, Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland
- Department of Medicine, Division of General Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Segna
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Gastroenterology and Hepatology, University Hospital of Zürich, Zurich, Switzerland
- Department of Gastroenterology, GZO Wetzikon, Wetzikon, Switzerland
| | - Carmen Floriani
- Institute of Primary Health Care (BIHAM, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Stefanie Aeschbacher
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Giorgio Moschovitis
- Division of Cardiology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Jürg Schläpfer
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Dipen Shah
- Cardiology Service, Department of Medicine Specialities, University Hospital Geneva, Geneva, Switzerland
| | - Peter Amman
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Richard Kobza
- Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
| | - Michael Kühne
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Leo H Bonati
- Neurology Division and Stroke Centre, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Jürg Beer
- Department of Medicine, Cantonal Hospital of Baden and Molecular Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Stefan Osswald
- Cardiology Division, Department of Medicine, University Hospital Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, Basel, Switzerland
| | - David Conen
- Cardiovascular Research Institute Basel, Basel, Switzerland
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM, University of Bern, Bern, Switzerland
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