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Background Stroke risk in atrial fibrillation (AF) using oral vitamin K antagonists (VKA) is closely related to bleeding risk.The HAS-BLED bleeding score has demonstrated its usefulness in assessing major bleeding risk in AF patients.However,risk factors for warfarin associated-bleeding also predict stroke risk in AF patients.We tested the usefulness of HAS-BLED score for predicting both major bleeding and cardiovascular events in a cohort of anticoagulated AF patients.Methods and Results We recruited 965 consecutive anticoagulated outpatients with permanent or paroxysmal AF who were stabilised for at least 6 months on oral anticoagulation (OAC;INR 2.0-3.0).Medical history and HAS-BLED score were assessed.Cox regression models were used to determine the association between clinical risk factors,and bleeding episodes,adverse cardiovascular events and mortality.The median HAS-BLED score was 2 (range 0-6;29% with a score ≥3,ie.high risk).Median follow-up was 861 (718-1016) days.Independent predictors for major bleeding were age ≥75 [HR:1.74 (1.05-2.87);P=0.030],male sex [HR:1.70 (1.03-2.80);P=0.036],renal impairment [HR 2.12 (1.20-3.73);0.010],previous bleeding episode [HR 6.00 (3.73-9.67);P < 0.001],current alcoholic consumption [HR 2.28 (1.03-5.06);P=0.043] and the concomitant malignant disease [HR 2.17 (1.13-4.18);P=0.020].Independent predictors for adverse cardiovascular events were age > 75y [HR 2.20 (1.40-3.46);P=0.001],heart failure [HR 1.78 (1.20-2.86);P=0.001] and previous stroke [HR 1.85 (1.20-2.86);P < 0.001].The HAS-BLED score was highly predictive for major bleeding events [HR 2.04 (1.68-2.49);P < 0.001],and for adverse cardiovascular events [HR 1.51 (1.27-1.81);P < 0.001].The incidence of both bleeding and adverse cardiovascular events was higher as HASBLED score increased,and crude bleeding rates only exceeded thrombotic events at a HAS-BLED score > 3.The HAS-BLED score also predicted all-cause mortality [HR 1.68 (1.40-2.01);P < 0.001].Conclusions The HAS-BLED score is not only useful in assessment of bleeding risk,but it showed some predictive value for cardiovascular events and mortality in anticoagulated AF patients,consistent with the relationship between thrombosis and bleeding.Nonetheless,the HAS-BLED score has been designed for predicting bleeding risk rather than thrombotic events per se,and specific risk scores for cardiovascular events and mortality should be applied for these events.
Background Stroke risk in atrial fibrillation (AF) using oral vitamin K antagonists (VKA) is closely related to bleeding risk. The HAS-BLED bleeding score has demonstrated its usefulness in assessing major bleeding risk in AF patients. However, risk factors for warfarin associated -bleeding also predict stroke risk in AF patients. We tested the usefulness of HAS-BLED score for predicting both major bleeding and cardiovascular events in a cohort of anticoagulated AF patients. Methods and Results We recruited 965 consecutive anticoagulated outpatients with permanent or paroxysmal AF who were stabilized for at least 6 months on oral anticoagulation (OAC; INR 2.0-3.0). Medical history and HAS-BLED score were evaluated. Cox regression models were used to determine the association between clinical risk factors, and bleeding episodes, adverse cardiovascular events and mortality. The median HAS-BLED score was 2 (range 0-6; 29% with a score ≥3, ie.high risk) .Median follow-up was 861 (718-1016) days.Independ (P = 0.030), male sex [HR: 1.70 (1.03-2.80); P = 0.036], renal impairment [HR 2.12 (1.20-3.73 P <0.001], current alcoholic consumption [HR 2.28 (1.03-5.06); P = 0.043] and the concomitant malignant disease [HR 2.17 (1.13-4.18 P = 0.001]. Previous failure [HR 1.78 (1.20-2.86); P = 0.001]. Previous stress [ HR 1.85 (1.20-2.86); P <0.001]. The HAS-BLED score was highly predictive for major bleeding events [HR 2.04 (1.68-2.49); P <0.001], and for adverse cardiovascular events [HR 1.51 1.81); P <0.001]. The incidence of both bleeding and adverse cardiovascular events was higher as HASBLED score increased, and crude bleeding rates only exceeded thrombotic events at a HAS-BLED score> 3. The HAS- BLED score also predicted all- cause mortality [HR 1.68 (1.40-2.01); P <0.001] .Conclusions Th e HAS-BLED score is not only useful in assessment of bleeding risk, but it showed some predictive value for cardiovascular events and mortality in anticoagulated AF patients, consistent with the relationship between thrombosis and bleeding. Nonetheless, the HAS-BLED score has been designed for predicting bleeding risk rather than thrombotic events per se, and specific risk scores for cardiovascular events and mortality should be applied for these events.