Comparative validation of HAS‐BLED, GARFIELD‐AF and ORBIT bleeding risk scores in Asian people with atrial fibrillation treated with oral anticoagulant: A report from the COOL‐AF registry

Abstract

AimsComparative data between the HAS‐BLED, GARFIELD‐AF and ORBIT score are limited in anticoagulated Asian patients with atrial fibrillation (AF). We compared the performance of the 3 scores in a nationwide registry.MethodsAF patients treated with oral anticoagulants in the COOL‐AF registry were studied. We fitted the variables of the HAS‐BLED, GARFIELD‐AF and ORBIT score to major bleeding in Cox model. We explored a modified HAS‐BLED by addition of sex and body weight. Discrimination, calibration, net reclassification index (NRI) and decision curve analysis were used to compare the performance of the 3 models.ResultsOf 3402 patients in the registry, 2568 patients who received oral anticoagulant at baseline were studied. Majority of patients (91.1%) received warfarin. The rate of major bleeding was 2.11 per 100 person‐years. The C‐statistics of the GARFIELD‐AF, HAS‐BLED, modified HAS‐BLED and ORBIT score were 0.65 (95% confidence interval [CI] 0.63–0.67), 0.66 (95%CI 0.64–0.68), 0.69 (95%CI 0.67–0.71) and 0.64 (95%CI 0.62–0.66) respectively. There was good agreement between predicted and observed bleeding in the deciles of HAS‐BLED and GARFIELD‐AF scores, while the modified HAS‐BLED score and ORBIT score overestimated the risk in the last decile. The modified HAS‐BLED score had superior NRI than the HAS‐BLED score (26.9%, 95%CI 9.7%–42.2%) and the ORBIT score (31.9%, 95%CI 9.0–53.6%). The NRI between the modified HAS‐BLED and GARFIELD‐AF score was similar. The net benefit curve of the 4 models were overlapping among different thresholds.ConclusionsThe clinical utility for bleeding prediction of GARFIELD‐AF, HAS‐BLED, modified HAS‐BLED and ORBIT scores were similar in anticoagulated Asian patients with AF participating in the COOL‐AF registry. We found no advantage of the ORBIT over HAS‐BLED score for bleeding risk prediction, even in direct oral anticoagulant users.