Comparison of Bleeding Risk Scores in Atrial Fibrillation Patients on Direct-Acting Oral Anticoagulants: A Real-Life Study
Yusuf İnci1
, Hasan Ali Barman2, Doğaç Okşen3, Ömer Doğan2, Abdullah Ömer Ebeoğlu2, Sercan Çayırlı5, Mehmet Rasih Sonsöz1, Mehmet Nail Bilen1, Sait Mesut Doğan4
1Department of Cardiology, Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
2Department of Cardiology, Institute of Cardiology, İstanbul University-Cerrahpaşa, İstanbul, Türkiye
3Department of Cardiology, Altınbaş University Faculty of Medicine, İstanbul, Türkiye
4Department of Cardiology, Gaziantep University, Gaziantep, Türkiye
5Department of Cardiology, Adnan Menderes University, Aydın, Türkiye
Keywords: ATRIA score; atrial fibrillation; bleeding risk; direct-acting oral anticoagulants; HEMORR2 HAGES score; ORBIT score.
Abstract
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 HEMORR2 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 HEMORR2 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 HEMORR2 HAGES (OR: 1.535, p=0.006) and ORBIT (OR: 1.849, p<0.014) scales.
Conclusion: Both the ORBIT and HEMORR2 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.
This study was derived from the medical specialty thesis of Dr. Yusuf İnci.
Cite This Article: İnci Y, Barman HA, Okşen D, Doğan Ö, Ebeoğlu AÖ, Çayırlı S, et al. Comparison of Bleeding Risk Scores in Atrial Fibrillation Patients on Direct-Acting Oral Anticoagulants: A Real-Life Study. Koşuyolu Heart J 2026;29(2):114–120