Relationship between HAS-BLED Score & Major Bleeding Events in Patients with Non-valvular Atrial Fibrillation on Warfarin: A Study at a Tertiary Care Teaching Hospital

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Vishwa Lokuhettige
Prabath Chathuranga
Chandima Kulathilake
Nishadya Ranasinghe
Sampatha Goonewardena
Vindya Kumarapeli

Abstract

Background: Prevention of stroke and thrombo-embolism in patients with atrial fibrillation(AF) using oral vitamin K antagonists is closely related to risk of bleeding. The HAS-BLED score has been evaluated as a predictor of major bleeding risk in various populations. The present study was conducted to evaluate the usefulness of the HAS-BLED score for predicting 1-year major bleeding risk in a cohort of Sri Lankan patients with non valvular atrial fibrillation on warfarin.

Materials and Methods: This was a retrospective cohort study conducted at anticoagulation outpatient clinics of a tertiary care teaching hospital, which included ninety one patients with non valvular atrial fibrillation on warfarin for at least 18 months. The relevant data were collected using an interviewer administered questionnaire and medical records of the patient. HAS-BLED score was calculated 6 months after the initial diagnosis and start of warfarin, using the retrospective information. The occurrence of major bleeding events during the period of following 01year was documented. The results were analyzed by obtaining a p value through Fisher exact test and using logistic regression analysis to assess the independent risk factors.

Results: Out of 91 patients, 47.25% (43/91) were males and 52.74% (48/91) were females. The median HAS-BLED score was 2. In this cohort, 06(6.6%) were in a low risk, 59(64.8%) were in an intermediate risk and 26(28.6%) were in a high risk of bleeding according to HAS-BLED score. There were 2 major bleeding events in the one year period with one each occurring in intermediate and high risk groups. But, the association was not statistically significant(Fisher exact test is 1.000, P=1.000). Logistic regression analysis did not show any significance of individual components of the score as independent risk factors for bleeding.

Conclusion: The data of our study showed a limited value of HAS-BLED score, as it had no statistically significant relationship with the major bleeding events in patients in our cohort. However, further studies using greater samples are recommended to draw further conclusions in our population.

Keywords:
Atrial fibrillation, warfarin, major bleeding, minor bleeding, risk of bleeding

Article Details

How to Cite
Lokuhettige, V., Chathuranga, P., Kulathilake, C., Ranasinghe, N., Goonewardena, S., & Kumarapeli, V. (2020). Relationship between HAS-BLED Score & Major Bleeding Events in Patients with Non-valvular Atrial Fibrillation on Warfarin: A Study at a Tertiary Care Teaching Hospital. Asian Hematology Research Journal, 3(2), 27-34. Retrieved from https://journalahrj.com/index.php/AHRJ/article/view/30130
Section
Original Research Article

References

Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines 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 European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2006;48:854 –906.

Atrial Fibrillation and Flutter in Sri Lanka Statistics on Overall Impact and Specific Effect on Demographic Group.

Available:http://global-disease-burden.healthgrove.com/l/44188/Atrial-Fibrillation-and-Flutter-in-Sri-Lanka.

Available:http://www.strokecenter.org/patients/about-stroke/stroke-statistics.

Camm AJ, et al. 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.

January CT, et al. 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:e1–76.

Lip GYH, Andreotti F, Fauchier L, Huber K, Hylek E, Knight E, et al. Bleeding risk assessmentand management in atrial fibrillation patients: A position document from the European Heart.

Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis. Europace [Internet]. 2011;13(5):723–46.

Available:https://academic.oup.com/europace/article-lookup/doi/10.1093/europace/ eur126

Proietti M, Senoo K, Lane DA, Lip GYH. Major bleeding in patients with non-valvular atrial fibrillation: Impact of time in therapeutic range on contemporary bleeding risk scores. Sci Rep. 2016;6(1): 24376.

Available:http://www.nature.com/articles/srep24376

Gallego P, Roldán V, Torregrosa JM, Gálvez J, Valdés M, Vicente V, et al. Relation of the HAS-BLED bleeding risk score to major bleeding, cardiovascular events, and mortality in anticoagulated patients with atrial fibrillation. Circ Arrhythmia Electrophysiol. 2012;5(2):312–8.9.

Zhu W, He W, Guo L, Wang X, Hong K. The HAS-BLED score for predicting major bleeding risk in anticoagulated patients with atrial fibrillation: A systematic review and meta-analysis. Clin Cardiol. 2015;38(9):555–61.

Larsen TB, Potpara T, Dagres N, Pison L, Estner H, Blomström-Lundqvist C. Stroke and bleeding risk evaluation in atrial fibrillation: results of the European Heart Rhythm Association survey. Europace [Internet]. 2014;16(5):698–702.

Available:http://www.ncbi.nlm.nih.gov/pubmed/24798958

Shah M, Tsadok MA, Jackevicius CA, Essebag V, Eisenberg MJ, Rahme E, et al. Warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation undergoing dialysis. Circulation. 2014; 129(11):1196–203.

Olesen JB, Lip GYH, Lindhardsen J, Lane DA, Ahlehoff O, Hansen ML, et al. Risks of thromboembolism and bleeding with thromboprophylaxis in patients with atrial fibrillation: A net clinical benefit analysis using a “real world” nationwide cohort study. Thromb Haemost [Internet]. 2011; 106(4):739–49.

Available:http://www.schattauer.de/index.php?id=1214&doi=10.1160/TH11-05-0364

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 Arrhythmia Electrophysiol. 2012;5(5):941–8.

Ruiz-Nodar JM, Marín F, Roldán V, Valencia J, Manzano-Fernández S, Caballero L, et al. Should we recommend oral anticoagulation therapy in patients with atrial fibrillation undergoing coronary artery stenting with a high HAS-BLED bleeding risk score? Circ Cardiovasc Interv. 2012;5(4):459–66.

Lip GYH, Frison L, Halperin JL, Lane DA. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol [Internet]. 2011;57(2):173–80. Available:http://dx.doi.org/10.1016/j.jacc.2010.09.024

Pisters R, Lane DA, Nieuwlaat R, De Vos CB, Crijns HJGM, Lip GYH. 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(5):1093–100.