Abstract 17655: Assessing Bleeding Risk in 4824 Asian Patients With Atrial Fibrillation: The Beijing PLA Hospital Atrial Fibrillation Project
Introduction: The risks of major bleeding and intracranial hemorrhage (ICH) are higher in Asian patients with atrial fibrillation (AF) compared to non-Asians.
Hypothesis: We aimed to investigate the risk factors, and validate the predictive value of available bleeding risk scores (mOBRI, HEMORR2HAGES, Shireman, HAS-BLED, ATRIA and ORBIT) in a large cohort of Chinese inpatients with AF.
Methods: Using hospital electronic medical databases, we identified 4824 AF patients (mean age 67 years; 34.9% female) from January 1,1995 to May 30, 2015, with median (interquartile) in-hospital days of 10(7-16) days.
Results: The rate of major bleeding (95% confidential interval, CI) was 1.14% (0.88%-1.48%), including intracranial hemorrhage(ICH) in 0.52%(0.35%-0.76%). On multivariate analysis, prior bleeds, vascular disease (carotid atherosclerosis, peripheral vascular disease, vascular amyloidosis, vascular dementia), anemia, prior stroke, and liver dysfunction were independent risk factors of major bleeding (all p<0.05). C-statistics(95%CI) of the HAS-BLED score were 0.72(0.65-0.79) for major bleeding events and 0.83(0.75-0.91) for ICH (all p<0.001). Compared to other risk scores, the HAS-BLED score was significantly better in predicting major bleeding events (Delong test, all P <0.05, apart from mOBRI, HEMORR2HAGES) and ICH (all p<0.05), and resulted in a NRI of 17.1%-65.5% in predicting major bleeding events and 29.5%-67.3% in predicting ICH (all p<0.05). The predictive ability of HAS-BLED remained in the elderly subgroup (major bleeding events and ICH: c-statistics 0.71(0.65-0.77) and 0.80(0.73-0.88), respectively, all p<0.001).
Conclusions: The HAS-BLED score had the best predictive ability for major bleeding and ICH in an Asian/Chinese AF population. Prior bleeding, vascular disease, anemia, prior stroke, and liver dysfunction were associated with major bleeding risk in this population.
Author Disclosures: Y. Guo: None. Y. Chen: None. G. Lip: None.
- © 2016 by American Heart Association, Inc.