HAS-BLED proves predictive ability

Aug 14 2012

By Piriya Mahendra, MedWire News Reporter

Researchers say that the HAS-BLED score is a significant predictor for intracranial hemorrhage when compared with the HEMORR₂HAGES and ATRIA scores, supporting international guideline recommendations.

Therefore, the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol) score may be an "attractive method" for estimating oral anticoagulant-related bleeding risk in patients, say Gregory Lip (City Hospital, Birmingham, UK) and team.

They found that HAS-BLED was the best predictor for any clinically relevant bleeding (defined as composite of major bleeding and clinically relevant nonmajor bleeding), demonstrated by respective net reclassification improvements of 10% and 13% when compared with the HEMORR₂HAGES (Hepatic or Renal Disease, Ethanol Abuse, Malignancy, Older Age, Reduced Platelet Count or Function, Re-bleeding, Hypertension, Anemia, Genetic Factors, Excessive Fall Risk and Stroke) and ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) scores.

Receiver-operating characteristic (ROC) analysis also showed that HAS-BLED had a significantly higher c-index than the other two scores, at 0.60 versus 0.55 and 0.50.

Decision-curve analysis revealed that the HAS-BLED score showed superior performance for clinically relevant bleeding compared with the HEMORR₂HAGES and ATRIA scores, at a threshold probability of 9% or more.

Moreover, HAS-BLED was the only score that demonstrated a significant predictive performance for intracranial hemorrhage, at a c-index of 0.75 (p=0.03).

"This comparison is of practical importance because bleeding risk-scoring systems are featured in management guidelines for stroke prevention in atrial fibrillation," comment the authors in the Journal of the American College of Cardiology.

They point out that the HAS-BLED score is recommended by European and Canadian guidelines.

"All 2 tested bleeding risk-estimation scores demonstrated only modest performance in predicting the outcome of any clinically relevant bleeding, although the HAS-BLED score performed better than the HEMORR₂HAGES and ATRIA scores," Lip and colleagues conclude.

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