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ARC-HBR score predicts better than HEMORR2HAGES the risk of major bleeding in patients with atrial fibrillation
Session:
Posters (Sessão 5 - Écran 1) - Fibrilhação auricular - clínica
Speaker:
Ana Filipa Mesquita Gerardo
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.8 Atrial Fibrillation - Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Filipa Gerardo; Aurora Monteiro; Inês Miranda; Inês Fialho; Mariana Passos; Carolina Mateus; Marco Beringuilho; Joana Lima Lopes; Daniel Faria; João Augusto
Abstract
<p style="text-align:center"> </p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:black"><strong>Background:</strong> The Academic Research Consortium for High Bleeding Risk (ARC-HBR) initiative aims to define HBR in patients undergoing percutaneous coronary intervention (PCI). Twenty clinical criteria are identified as major or minor by consensus and patients are considered to be at HBR if at least 1 major or 2 minor criteria are met. HEMORR2HAGES is used to predict HBR in patients with atrial fibrillation (AF), as the benefits of anticoagulation come at the cost of an increased risk of bleeding. </span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:black"><strong>Purpose:</strong> This study aims to validate the ARC-HBR predicting scheme in patients with AF and compare them with the HEMORR2HAGES predicting scheme in assessing bleeding risk.</span></span></span></p> <p style="text-align:justify"><br /> <span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:black"><strong>Methods:</strong> In this single-centre retrospective study, 2181 consecutive patients with AF who were evaluated in our emergency department (ED) between June 2014 and December 2015 were analyzed. Among them, 423 patients were admitted for in-hospital management. Clinical characteristics, interventions, blood markers and bleeding outcomes were recorded. The primary outcome was clinically relevant bleeding, defined as Bleeding Academic Research Consortium (BARC) 2, 3 or 5 bleeding, during a follow-up period of 12 months. HEMORR2HAGES predicting scheme was compared to ARC-HBR major criteria only predicting scheme (a multivariable risk score with the following criteria: </span><span style="color:#222222">anticipated long-term anticoagulation after PCI; severe or end-stage chronic kidney disease; anemia; spontaneous bleeding requiring hospitalization or transfusion in the previous 6 months; moderate or severe thrombocytopenia; chronic bleeding diathesis; cirrhosis with portal hypertension; active malignancy in the previous 12 months; presence of brain arteriovenous malformation, previous spontaneous intracranial hemorrhage (ICH) at any time, previous traumatic ICH in the previous 12 months, moderate or severe ischemic stroke in the previous 6 months; nondeferrable major surgery on dual antiplatelet therapy or major surgery or major trauma in the 30 days before PCI</span>)<span style="color:black">. </span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:black"><strong>Results:</strong> A total of 384 patients (90.5%) were discharged (the remainder being in-hospital deaths); mean age was 72.8 ± 12.4 years, 41.1% were males. Follow-up was possible in 98.5%. Bleeding occurred in 3.6% of cases, of which 60% required a blood transfusion. The discriminative ability of the ARC-HBR major criteria was good. The area under the curve (AUC) for the receiver-operator characteristics curve for HEMORR2HAGES was 0.871 (p<0.001; 95% confidence interval [CI] 0.793-0.950) and for ARC-HBR major criteria was 0.810 (p<0.001, 95% CI 0.730-0.890). An ARC-HBR major only criteria score >1.5 has a sensitivity of 93.3% and a specificity of 68.1%.</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:14px"><span style="color:black"><strong>Conclusions: </strong>In this single-centre study with patients hospitalized with atrial fibrillation, the ARC-HBR major criteria score performs similarly to HEMORR2HAGES in predicting bleeding risk.</span></span></span></p>
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