Objective: To demonstrate bleeding risk prediction of simplified HAS-BLED (sHAS-BLED) score in anticoagulated patients with atrial fibrillation (AF).

Materials and Methods: AF patients receiving warfarin were retrospectively recruited in Central Chest Institute of Thailand between October 2012 and December 2017. The main outcome was total bleeding including major bleeding, clinically relevant non-major bleeding or minor bleeding. The chi-square test or Fisher’s exact test was used to compare the main outcome between sHAS-BLED and conventional HAS-BLED (cHAS-BLED) scores. A sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of sHAS-BLED were calculated. The discrimination performances of sHAS-BLED and cHAS-BLED scores were demonstrated with c-statistics.

Results: One hundred ten patients were recruited. The mean age was 70.53±9.58 years. The average sHAS-BLED and cHAS-BLED scores were 2.23±0.79 and 1.95±0.83, respectively. The patients with sHAS-BLED score of 3 or more had 15 total bleeding events (37.50%) while those with score of less than 3 had 13 total bleeding events (18.57%). Those with sHAS-BLED score of 3 or more had more total bleeding than those with score of less than 3 with statistical significance (odds ratio 2.63; 95% CI 1.09 to 6.25; p=0.049). A sensitivity, specificity, PPV, and NPV of sHAS-BLED score were 53.57%, 69.51%, 37.50%, and 81.43%, respectively. The discrimination performances of sHAS-BLED and cHAS-BLED scores were demonstrated with c-statistics of 0.65 and 0.67, respectively.

Conclusion: The sHAS-BLED score can be used for bleeding risk prediction in anticoagulated AF patients compared with cHAS-BLED score.

Keywords: Simplified HAS-BLED, Atrial fibrillation, Anticoagulant, Bleeding, SAMe-TT₂R₂

DOI: doi.org/10.35755/jmedassocthai.2021.05.12142

Received 2 November 2020 | Revised 15 February 2021 | Accepted 15 February 2021