Use of simplified HAS‐BLED score in patients with atrial fibrillation receiving warfarin

BACKGROUND: Oral anticoagulant drugs are proven to prevent thromboembolism in patients with atrial fibrillation (AF). To date, HAS‐BLED score is used to assess bleeding risk. This study was conducted to compare simplified HAS‐BLED (sHAS‐BLED) with conventional HAS‐BLED (cHAS‐BLED) scores. METHODS: This retrospective study recruited patients with AF receiving warfarin among July 2013 to December 2018 in Central Chest Institute of Thailand. The cHAS‐BLED score used the time in therapeutic range less than 70% as labile INR, whereas sHAS‐BLED score used SAMe‐TT(2)R(2) score of 3 or more as a substitute for labile INR. A paired Student's t test was used to compare sHAS‐BLED and cHAS‐BLED. The Pearson's correlation was used to assess the correlation of sHAS‐BLED to cHAS‐BLED scores. The Bland‐Altman plot was used to confirm the agreement of individual sHAS‐BLED to cHAS‐BLED score. RESULTS: A total of 126 AF patients were enrolled. The average age, SAMe‐TT(2)R(2) score, and cHAS‐BLED score were 70.52 ± 10.37 years, 3.53 ± 1.03, and 2.03 ± 0.95, respectively. The sHAS‐BLED score was not statistically significantly different compared with cHAS‐BLED score (P = .08). The sHAS‐BLED and cHAS‐BLED scores had a very strong correlation with a correlation coefficient of .86 (P < .01). The Bland‐Altman plot was performed to confirm the agreement of individual sHAS‐BLED to cHAS‐BLED scores. CONCLUSIONS: The sHAS‐BLED was not statistically significantly different compared with cHAS‐BLED and can be used in clinical practice. However, larger clinical trial will be needed to prove whether sHAS‐BLED can predict bleeding risk in the future.