HAS-BLED outclasses DOAC, ORBIT scores in predicting bleeding in nonvalvular AF

In patients with nonvalvular atrial fibrillation (AF), the best predictor of major bleeding was the HAS-BLED score, demonstrating similar efficacy to the DOAC score and superiority to the ORBIT score, suggests a China study.

A total of 2,532 Chinese patients with nonvalvular AF (mean age 71.7 years, 58.5 percent men) were included in this real-world retrospective study. The researchers then compared the DOAC score to the HAS-BLED and ORBIT scores by measuring their discrimination, calibration, net reclassification index (NRI), and decision curve analysis (DCA) over 1 year of follow-up.

Of the patients, 91 had major bleeding (3.59 percent per year), 44 had intracranial haemorrhage (ICH) events (1.74 percent per year), and 49 had gastrointestinal (GI) bleeding (1.94 percent per year).

HAS-BLED score was the best predictor for major bleeding (area under the receiver operating characteristic curve [AUC], 0.674). Specifically, HAS-BLAD score ≥3 was most effective in predicting major bleeding (AUC, 0.642), followed by DOAC score ≥8 (AUC, 0.615) and ORBIT score ≥4 (AUC, 0.583).

The DOAC and HAS-BLED scores showed similar discrimination of major bleeding events and risk stratification.

Notably, the HAS-BLED score outdid the other two scores in calibration performance. In decision curve analysis, use of the HAS-BLED score in predicting major bleeding and ICH was “clinically beneficial.” However, no significant differences were noted among the three models in predicting GI bleeding.

“The DOAC score does not seem to be more suitable for Chinese patients than the HAS-BLED score,” the researchers said.