Importance of HAS-Bled Score in Patients on Warfarin Therapy for Atrial Fibrillation

ABSTRACT

Introduction: Bleeding is a significant complication whenpatients are on anticoagulant therapy. The risk of bleedingoverall when anticoagulant therapy is used is 3.8%. A numberof risk factors are associated with increased bleeding whenpatients are on anticoagulants. A practical risk score HASBLED score was developed to estimate 1year risk for majorbleeding in patients with atrial fibrillation. This study aimedto understand to assess the relevance of HAS-BLED scorein predicting bleeding in patients coming to AJ institute ofmedical sciences.Material and methods: We conducted a case control studyin patients on Warfarin therapy for Atrial fibrillation whopresented with major bleeding manifestations betweenSeptember2017-2018 in a tertiary care centre in AJ InstituteOf Medical Sciences in South India. Patients or their medicalpower of attorneys provided written informed consent. Atotal no of 100 patients were enrolled based on the inclusioncriteria patients aged more than 18 years. They were groupedinto cases who had bleeding and controls who did not havebleeding. HAS BLED score was calculated. The data wasentered in Microsoft Excel and was analysed with SPSSResults: Total of 100patients (50cases and 50controls) werestudied. On analysing the HAS-BLED score the P valueshowed significant difference between the case and controlgroups. The sensitivity was 80% and specificity was 68%. Thepositive and negative predictive value of HAS-BLED valueswere 71.4% and 77.27% respectively.Conclusion: Our study emphasises the need for making betteruse of HAS-BLED score in predicting bleeding and the needfor monitoring the INR regularly and educating patients onWarfarin therapy about frequent monitoring, the risks ofbleeding and to seek early medical attention on developingbleeding.