Comparison of Bleeding Risk Scores in Atrial Fibrillation Patients on Direct-Acting Oral Anticoagulants: A Real-Life Study

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Objective: Hemorrhagic complications continue to be a major clinical challenge among individuals with atrial fibrillation (AF) receiving direct-acting oral anticoagulants (DOACs). This research sought to evaluate and contrast the accuracy of various risk assessment models in forecasting bleeding incidents within this specific patient cohort. Methods: We enrolled 447 subjects diagnosed with AF who were prescribed DOAC therapy (including apixaban, dabigatran, edoxaban, or rivaroxaban). By retrospectively reviewing institutional electronic health records, we computed the ORBIT, ATRIA, and HEMORR 2 HAGES risk indices for each participant. The main outcome measures were defined as the occurrence of clinically relevant minor or major hemorrhages. Consequently, we analyzed how accurately these scoring systems could foresee the specified endpoints. Results: The cohort’s average age stood at 75.6±10.1 years, comprising predominantly women (62.2%). During a 12-month observation period, 6.7% of the participants (n=30) encountered one or more major hemorrhagic events. When forecasting severe bleeding, the ATRIA, ORBIT, and HEMORR 2 HAGES frameworks exhibited comparable predictive accuracies without any statistically notable variations. Upon conducting a multivariate logistic regression, independent variables linked to a heightened likelihood of bleeding encompassed prior hemorrhagic episodes (odds ratio [OR]: 3.101, p=0.019) and the presence of heart failure (OR: 2.028, p=0.009). In addition, anemia emerged as a significant factor (OR: 0.366, p=0.049), alongside elevated evaluations in both the HEMORR 2 HAGES (OR: 1.535, p=0.006) and ORBIT (OR: 1.849, p<0.014) scales. Conclusion: Both the ORBIT and HEMORR 2 HAGES models proved to be valuable independent indicators for future hemorrhagic complications. Integrating these tools into routine cardiovascular care can optimize therapeutic strategies and enhance the overall safety of AF patients on anticoagulation.

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