INTRODUCTION. HAS-BLED score was developed to assess 1-year major bleeding risk in patients anticoagulated with vitamin K antagonists (VKA) due to atrial fibrillation (AF). HAS-BLED score includes ?labile INR? referred to quality of anticoagulation, i.e., time in therapeutic range (INR 2.0-3.0) < 60%. However, in naive patients this item is not available. Aim of this study was to evaluate if the HAS-BLED score in its refined form excluding ?labile INR? (HAS-BED) is still associated with bleeding risk. PATIENTS AND METHODS. A retrospective cohort study was conducted including patients with AF treated at a tertiary hospital anticoagulation outpatient clinic. C-statistic was performed to evaluate the ability of these scores in predicting major bleeding. ROC curves were compared through DeLong test. RESULTS. We studied 263 patients with a mean age (SD) of 71.1 ± 10.5 years over a period of 237.6 patients-year, being 124 (47.1) with a ?labile INR?. Median (IQR) HAS-BLED and HAS-BED scores were 2 (1-3). The overall incidence of major bleeding was 5.7%. High risk HAS-BLED score patients (score ? 3) presents higher frequency of major bleeding as compared to low risk patients (9.6 vs. 3.1%; P = 0.052). This also occurred with high risk HAS-BED score patients (12.9 vs. 3.1%; P = 0.005). Area under the ROC curve was 0.696 (P = 0.01) for HAS-BLED score and 0.694 (P = 0.01) for HAS-BED score (P = 1.0). CONCLUSION. In our retrospective cohort of AF patients, HAS-BED score was also able to identify patients at high major bleeding risk. This information could be useful in AVK naive patients undergoing major bleeding risk assessment.
Autores: GUILHERME DAGOSTIN DE CARVALHO, Fernando Pivatto Júnior, André Luís Ferreira Azeredo da Silva, Luís Carlos Amon, Marina Bergamini Blaya, Rafael Coimbra Ferreira Beltrame, Rafael Selbach Scheffel