NewBleedingScore,HAS-BLED,WillHelpGuideAnticoagulationinAF(2011-01-0623:45:06)January5,2011(Birmingham,UnitedKingdom)—Anovelscoreforpredictingbleedingriskinpatientswithatrialfibrillation(AF),calledHAS-BLED,performedbetterthananyothercontemporaryscoreinalargecohortofanticoagulatedpatients;thescorecouldbecomeanimportantnewclinicaltool,sayresearchers[1].ThisisthesecondvalidationofHAS-BLED;itwasderivedfromandfirstvalidatedinaEuropeanAFpopulationlastyear[2].HAS-BLEDispragmatic;it'saneasyassessmentandhelpsdoctorstomakeaninformeddecisionratherthanguessing."HAS-BLEDispragmatic;it'saneasyassessmentandhelpsdoctorstomakeaninformeddecisionratherthanguessing.It'stheretotellyou,ifthebleedingscoreishighenough,thatmorecautionormoreregularreviewofyourpatientisneeded,"theleadauthorofthenewpaper,DrGregoryYHLip(UniversityofBirmingham,UK),toldheartwire.LippointsoutthatuseofHAS-BLEDisrecommendedinthenewEuropeanSocietyofCardiology(ESC)guidelinesonAFaswellinthelatestguidanceonAFfromtheCanadianCardiovascularSociety.InaneditorialaccompanyingLipetal'spaper[3],DrStefanHHohnloser(JWGoetheUniversity,Frankfurt,Germany)saysthatHAS-BLEDisan"importantstep"and"mayindeedprovetobeanimportantclinicaltooltoassessbleedingriskinAFpatients."However,hecautionsthatitremainstobeseenhowitwillperformindailyroutinepracticeandwhethersuchableedingscore--developedfromdataonpatientsreceivingwarfarinandothervitamin-Kantagonists--canalsobeappliedduringuseoftheneweranticoagulants,whichmayhavelesserbleedingrisks.ASimpleToolThatWillBeInvaluabletoCardiologistsLipsaysthatoptimumselectionofpatientswithAFforanticoagulationtherapydependsnotonlyonassessmentoftheirriskofstrokebutalsoonidentificationofthoseatincreasedriskofdevelopingbleedingcomplications.Hohnloseragrees,notingthatcurrentlyanticoagulationtherapyinAFis"underused,suboptimallyapplied,andofteninappropriatelydiscontinued...drivenforagoodpartbytheperceivedbleedingriskassociated"withwarfarintherapy.TheHAS-BLEDscoreissimpletoremember,saysLip,andcouldbecomeinvaluabletocardiologistsas,withtheadventofneweroralanticoagulants,anticoagulationwillmigratetobecometheirresponsibility.Thefirstoftheseneweragents,dabigatran(Pradaxa,BoehringerIngelheim),wasrecentlyapprovedforthepreventionofstrokeinpatientswithAFintheUSandCanada,andothernewdrugsarealsoclosetothemarketforthisindication.BayerandJohnson&JohnsonannouncedtodaythattheyhadfiledformarketingapprovalforrivaroxabanwithboththeEuropeanMedicinesAgencyandtheFDAforstrokepreventioninAF."Atthemoment,ifImakeadecisiononoralanticoagulationinapatientwithAF,Iwriteontheform,'needswarfarin,'andthatpatientbecomestheresponsibilityofthehematologistinthewarfarinclinic,andIdon'thavetoworryaboutthem.ButwewillsoonbeinthesituationlaterthisyearwherewewillhavenewanticoagulantsforAF,thefirstofwhichislikelytobedabigatran,andI,asacardiologistsittinginmyoffice,willhavetomakeadecision:doIchoose110mgor150mg(twicedaily),or75mgifIamintheUS?"hesays.HeagreeswithHohnloser,however,thatmoreworkneedstobedonetoevaluatethescorewiththeseneweragents;forexample,furthervalidationofHAS-BLEDinrelationtodabigatrandosewillbenecessary,hesays.WhatIstheHAS-BLEDScoreandHowIsItCalculated?HAS-BLEDstandsforhypertension,abnormalrenal/liverfunction,stroke,bleedinghistoryorpredisposition,labileINR,elderly(ageover65),anddrugs/alcoholconcomitantly;themaximumpossiblescoreis9--with1pointforeach...
