Scoring Systems for Estimating the Risk of Anticoagulant-Associated Bleeding

2017 ◽  
Vol 43 (05) ◽  
pp. 514-524 ◽  
Author(s):  
Anna Parks ◽  
Margaret Fang
Keyword(s):  
Clinical Practice ◽  
Risk Index ◽  
Predictive Ability ◽  
Scoring Systems ◽  
Bleeding Risk ◽  
Assessment Tools ◽  
Risk Scores ◽  
Bleeding Complications ◽  
Individual Risk ◽  
Thrombosis Risk

AbstractAnticoagulant medications are frequently used to prevent and treat thromboembolic disease. However, the benefits of anticoagulants must be balanced with a careful assessment of the risk of bleeding complications that can ensue from their use. Several bleeding risk scores are available, including the Outpatient Bleeding Risk Index, HAS-BLED, ATRIA, and HEMORR2HAGES risk assessment tools, and can be used to help estimate patients' risk for bleeding on anticoagulants. These tools vary by their individual risk components and in how they define and weigh clinical factors. However, it is not yet clear how best to integrate bleeding risk tools into clinical practice. Current bleeding risk scores generally have modest predictive ability and limited ability to predict the most devastating complication of anticoagulation, intracranial hemorrhage. In clinical practice, bleeding risk tools should be paired with a formal determination of thrombosis risk, as their results may be most influential for patients at the lower end of thrombosis risk, as well as for highlighting potentially modifiable risk factors for bleeding. Use of bleeding risk scores may assist clinicians and patients in making informed and individualized anticoagulation decisions.

scholarly journals Predictive ability of bleeding risk scores in the routine clinical practice

2014 ◽  
Vol 4 (3) ◽  
pp. 205-210 ◽  
Author(s):  
Albert Ariza-Solé ◽  
Joel Salazar-Mendiguchía ◽  
Victòria Lorente ◽  
José Carlos Sánchez-Salado ◽  
Rafael Romaguera ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Predictive Ability ◽  
Bleeding Risk ◽  
Routine Clinical Practice ◽  
Risk Scores

The risk of bleeding with warfarin: A systematic review and performance analysis of clinical prediction rules

2007 ◽  
Vol 98 (11) ◽  
pp. 980-987 ◽  
Author(s):  
Karen Dahri ◽  
Peter Loewen
Keyword(s):  
Systematic Review ◽  
Major Bleeding ◽  
Warfarin Therapy ◽  
Risk Index ◽  
Predictive Ability ◽  
Bleeding Risk ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Risk Of Bleeding

SummaryIt was the objective of this article to qualitatively review and evaluate the clinical prediction rules (CPRs) available for estimating bleeding risk in patients commencing warfarin therapy. A systematic review of PubMed (1949 to December 2006), MEDLINE (1966 to December 2006); EMBASE (1980 to December 2006), Cochrane Database of Systematic Reviews (to December 2006), and International Pharmaceutical Abstracts (1970 to Demember 2006) was conducted. Seven studies were found that detailed CPRs used to assess risk of bleeding prior to commencing warfarin therapy. Four studies described distinct CPRs. The remaining three studies were further validations of one of the CPRs, the Outpatient Bleeding Risk Index. The Outpatient Bleeding Risk Index was classified as being of Level 2 evidence while the remaining three indices were classified as being of Level 4 evidence. In no case did the CPRs exhibit performance characteristics that would indicate“strong” ability to predict the presence of absence of major bleeding among warfarin recipients. The modified Outpatient Bleeding Risk Index exhibited moderate predictive ability for major bleeding in two studies, although pooling of all studies of this CPR did not reveal moderate or better performance. None of the CPRs identified “any bleeding” with moderate or strong predictive ability. None of the available CPRs exhibit sufficient predictive accuracy or have trials evaluating the impact of their use on patient outcomes. Hence, no existing CPR can be recommended for widespread use in practice at present.

scholarly journals Current Concepts on Antiplatelet Therapy: Focus on the Novel Thienopyridine and Non-Thienopyridine Agents

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
L. Testa ◽  
G. G. L. Biondi Zoccai ◽  
M. Valgimigli ◽  
R. A. Latini ◽  
S. Pizzocri ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Practice ◽  
Drug Targeting ◽  
Bleeding Risk ◽  
Daily Practice ◽  
Adenosine Diphosphate ◽  
Bleeding Complications ◽  
The Novel ◽  
Platelet Activity ◽  
Risk Of Bleeding

Thienopyridines are a class of drug targeting the platelet adenosine diphosphate (ADP) 2 receptor. They significantly reduce platelet activity and are therefore clinically beneficial in settings where platelet activation is a key pathophysiological feature, particularly myocardial infarction. Ticlopidine, the first of the class introduced to clinical practice, was soon challenged and almost completely replaced by clopidogrel for its better tolerability. More recently, prasugrel and ticagrelor have been shown to provide a more powerful antiplatelet action compared to clopidogrel but at a cost of higher risk of bleeding complications. Cangrelor, a molecule very similar to ticagrelor, is currently being evaluated against clopidogrel. Considering the key balance of ischemic protection and bleeding risk, this paper discusses the background to the development of prasugrel, ticagrelor, and cangrelor and aims to characterise their risk-benefit profile and possible implementation in daily practice.

scholarly journals Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes?

2016 ◽  
Vol 35 (12) ◽  
pp. 637-644
Author(s):  
Alberto Garay ◽  
Albert Ariza-Solé ◽  
Francesc Formiga ◽  
Victoria Lorente ◽  
José C. Sánchez-Salado ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Predictive Ability ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Coronary Syndromes

scholarly journals The Performance of the HATCH Score for Predicting New-Onset Atrial Fibrillation in An Elderly Hospital-Based Chinese Population

2021 ◽  
Author(s):  
Haiyun Wu ◽  
Ruozhu Dai ◽  
Min Wang ◽  
Chengbo Chen
Keyword(s):  
Atrial Fibrillation ◽  
Chinese Population ◽  
Cox Regression ◽  
Predictive Ability ◽  
Scoring Systems ◽  
The Elderly ◽  
Individual Risk ◽  
Cox Regression Analysis ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract BACKGROUND: The aging population represents high risk in developing new-onset atrial fibrillation (NOAF). Assessing individual risk of NOAF is pivotal for primary prevention. The role of the HATCH score for predicting NOAF in the elderly hospital-based Chinese population has never been evaluated.METHODS: In our center, the development of NOAF was followed among patients aged over 65 years. Incidence of NOAF was calculated. Risk factors for NOAF were investigated using uni- and multivariable Cox regression analysis. The performance of the HATCH score for predicting NOAF was evaluated using Kaplan-Meier curve analysis with DeLong test and C-indexes.RESULTS: A total of 7718 elderly patients were enrolled in the present study, with 421 developed NOAF during 3.18 ± 3.73 years of follow-up with an incidence of 1.71 (95%CI 1.55-1.89) per 100 patient-years. After adjusted with cofounders, only hypertension (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.23-1.85), COPD (HR 1.86, 95%CI 1.22-2.84) and HF (HR 1.82, 95%CI 1.28-2.59) were independently related to NOAF. The risk of NOAF increased with a higher HATCH score (38% higher risk per 1-point increase). Among those with a HATCH score ≥4, the risk of NOAF was 4.01 (95%CI 3.85-4.16) per 100 patient-years (Log-rank P <0.001). The C-index for the HATCH score was moderate (0.60 [95%CI, 0.57-0.63]), which was better than the single criteria but comparative to other scoring systems.CONCLUSION: In this elderly hospital-based Chinese population, the HATCH score had a moderate predictive ability for NOAF.

Risk Assessment Models for Thrombosis and Anticoagulant-Related Bleeding in Ambulatory Cancer Patients

2021 ◽  
Author(s):  
Noori A.M. Guman ◽  
Matteo Candeloro ◽  
Noémie Kraaijpoel ◽  
Marcello Di Nisio
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Arterial Thrombosis ◽  
Risk Scores ◽  
Bleeding Complications ◽  
Individual Risk ◽  
Risk Assessment Models ◽  
Increased Risk ◽  
Cancer Associated Thrombosis

AbstractCancer patients have a high risk of developing venous thromboembolism and arterial thrombosis, along with an increased risk of anticoagulant-related bleeding with primary and secondary prophylaxis of cancer-associated thrombosis. Decisions on initiation, dosing, and duration of anticoagulant therapy for prevention and treatment of cancer-associated thrombosis are challenging, as clinicians have to balance patients' individual risk of (recurrent) thrombosis against the risk of bleeding complications. For this purpose, several dedicated risk assessment models for venous thromboembolism in cancer patients have been suggested. However, most of these scores perform poorly and have received limited to no validation. For bleeding and arterial thrombosis, no risk scores have been developed specifically for cancer patients, and treatment decisions remain based on clinical gestalt and rough and unstructured estimation of the risks. The aims of this review are to summarize the characteristics and performance of risk assessment scores for (recurrent) venous thromboembolism and discuss available data on risk assessment for bleeding and arterial thrombosis in the cancer population. This summary can help clinicians in daily practice to make a balanced decision when considering the use of risk assessment models for cancer-associated venous thromboembolism. Future research attempts should aim at improving risk assessment for arterial thrombosis and anticoagulant-related bleeding in cancer patients.

scholarly journals A94 RECURRENT HEPATOCELLULAR CARCINOMA: EVALUATION OF 8 POST-TRANSPLANT SCORING SYSTEMS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 110-110
Author(s):  
S Aziz ◽  
K Qumosani ◽  
A Teriaky
Keyword(s):  
Hepatocellular Carcinoma ◽  
Risk Assessment ◽  
Liver Transplantation ◽  
Preliminary Data ◽  
Predictive Ability ◽  
Assessment Tools ◽  
Risk Scores ◽  
Term Survival ◽  
Post Transplant ◽  
Hcc Recurrence

Abstract Background Recurrence of hepatocellular carcinoma (HCC) after liver transplantation is a major cause of morbidity and mortality. It is well known that there is a discordance between pre-transplant imaging and post-transplant pathology that affect risk of recurrence. Several risk assessment tools have been developed, although to date, there is no widely accepted tool to predict HCC recurrence. Aims The aim of the current study is to determine which pathologic risk assessment score has the best predicative ability. Methods We retrospectively evaluated 152 patients over a twelve-year period that underwent liver transplantation for HCC. Using explanted pathology reports, each patient was stratified according to the pathologic risk score and followed over time for HCC recurrence. We evaluated eight pathologic risk scores and determined predictive ability by assessing the area under the receiver operating characteristic curve (AUROC). Results Out of 152 consecutive liver transplants for HCC, recurrence occurred in 21 patients (14%) with a mean follow-up of 59.5 months. 54% of patients were within Milan criteria prior to transplant. According to explant pathology, microvascular invasion was seen in 16% of patients, with majority of the tumors being moderately differentiated (48%), tumor size ≥ 3cm (52%), and 26% of tumors in both lobes of the liver. Preliminary data suggests that the Parfitt et. al score has the best predictive ability, with 60% of recurrence occurring in those considered high-risk. Further assessment via AUROC will be required to confirm the preliminary data. Conclusions Preliminary data suggests the Parfitt et al. score may have the best predictive ability to detect recurrence. This risk assessment tool can help tailor a surveillance strategy for early detection or early adjuvant therapy to improve long-term survival. Funding Agencies None

Risk Stratification Models in Atrial Fibrillation

2017 ◽  
Vol 43 (05) ◽  
pp. 505-513 ◽  
Author(s):  
Farhan Shahid ◽  
Gregory Lip
Keyword(s):  
Atrial Fibrillation ◽  
Risk Assessment ◽  
Bleeding Risk ◽  
Practical Method ◽  
Assessment Tools ◽  
Risk Scores ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
Morbidity Risk ◽  
Aid Decision

AbstractAtrial fibrillation (AF) is associated with an increased risk of stroke compared with the general population. AF-related stroke confers a higher mortality and morbidity risk, and thus, early detection and assessment for the initiation of effective stroke prevention with oral anticoagulation are crucial. Simple and practical risk assessment tools are essential to facilitate stroke and bleeding risk assessment in busy clinics and wards to aid decision making. At present, the CHA2DS2VASc score is recommended by guidelines as the most simple and practical method of assessing stroke risk in AF patients. Alongside this, the use of the HAS-BLED score aims to identify patients at high risk of bleeding for more regular review and follow-up, and draws attention to potentially reversible bleeding risk factors. The aim of this review article is to summarize the current risk scores available for both stroke and bleeding in AF patients, and the recommendations for their use.

Sign in / Sign up

Export Citation Format

Share Document