Assessing the applicability of the DOAC, HAS-BLED and ORBIT risk scores in Chinese patients on non-vitamin K antagonist oral anticoagulants

Aims: The suitability of the DOAC score for assessing bleeding risk in Chinese patients with atrial fibrillation (AF) who are receiving non-vitamin K antagonist oral anticoagulants (NOACs) remains unclear. We compared the DOAC score to the HAS-BLED and ORBIT scores in Chinese patients in a real-world retrospective study.

Methods: The efficacy of these scores was assessed by a comparison study that measured their discrimination, calibration, net reclassification index (NRI), and decision curve analysis (DCA) over a 1-year follow-up period.

Results: Among 2532 patients with non-valvular AF (mean age, 71.7 ± 11.3 years, 58.5% men), major bleeding (MB) occurred in 91 patients (3.59%/year): 44 intracranial haemorrhage (ICH) events (1.74%/year) and 49 gastrointestinal bleeding (GB) events (1.94%/year). The best predictor for MB was the HAS-BLED score (area under the receiver operating characteristic curve [AUC], 0.674). HAS-BLED score ≥3 provided the best prediction for MB (AUC, 0.642), followed by DOAC score ≥8 and ORBIT score ≥4 (AUCs of 0.615 and 0.583, respectively). The DOAC and HAS-BLED scores did not differ significantly in discriminating MB events and risk reclassification. The calibration performance of the HAS-BLED score was superior to that of the other two scores. Decision curve analysis showed that using the HAS-BLED score to predict MB and ICH is clinically beneficial. However, there were no significant distinctions among the three models in forecasting GB.

Conclusions: In a non-valvular AF Chinese patients receiving NOACs, the HAS-BLED score showed an ability to predict MB comparable to that of the DOAC score and superior to that of the ORBIT score. The DOAC score does not seem to be more suitable for Chinese patients than the HAS-BLED score.