Predicting clinically relevant bleeding in new-onset atrial fibrillation patients initiating oral anticoagulant therapy: External validation of the AF-BLEED score.
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van der Horst S F B, Chu G, Seelig J, Trinks-Roerdink E M, Voorhout L, de Vries T A C, van Alem A P, Beukema R J, Boersma L V A, Brouwer M A, Ten Cate H, Faber L M, de Groot J R, Gu Y L, den Hartog F R, de Jong J S S G, de Jong Y, Kirchhof C J H J, Kleijwegt F S, Klok F A, Kruip M J H A, Lenderink T, Luermans J G, Meeder J G, Otten A M, Pisters R, Pos L, Prins F J, Römer T J, Smeets F, Tahapary G J M, Theunissen L J H J, Tieleman R G, Timmer S A J, Tichelaar V, Trines S A, van der Voort P, Velthuis S, de Vrey E A, Walhout R J, Hemels M E W, Rutten F H, Geersing G J, Huisman M V
Аннотация
AIMS: Evaluate the incidence of clinically relevant bleeding, and externally validate the AF-BLEED score in new-onset AF/AFL patients.
METHODS: Patients enrolled in the DUTCH-AF registry, who started OAC at diagnosis were studied. AF-BLEED categorized patients as low-risk (score ≤ 3) or high-risk (score > 3) for bleeding. Outcomes were first (i) MB and (ii) composite MB and clinically relevant non-major bleeding (CRNMB), with death and OAC discontinuation as competing events. Discrimination (cumulative AUC [AUCt]) was evaluated at 180 days and 2 years.
RESULTS: 4647 patients (AF-BLEED low-risk: 94.0 %) were included. Cumulative MB incidences for low- and high-risk patients were 0.58 % (95 %CI 0.34-0.82 %) and 1.65 % (0.04-3.26 %) at 180 days (p 0.04), and 1.82 % (1.39-2.26 %) and 5.07 % (2.26-7.87 %) at 2 years (p < 0.001), respectively. Cumulative CRNMB/MB incidences for low- and high-risk patients were 1.81 % (1.39-2.24 %) and 4.13 % (1.62-6.65 %) at 180 days (p 0.01), and 6.37 % (5.58-7.16 %) and 9.68 % (5.91-13.45 %) at 2 years (p 0.04), respectively. Discrimination was poor to moderate for both outcomes at both time windows, ranging between 0.51 and 0.62.
CONCLUSION: Although AF-BLEED was associated with subsequent risk of clinically relevant bleeding, its discriminative ability was poor, limiting the practical utility in its current form.