HAS-BLED: Atrial fibrillation patients undergoing angioplasty can still take anticoagulants

By Piriya Mahendra

Researchers say that oral anticoagulation could improve the prognosis of atrial fibrillation (AF) patients who undergo percutaneous coronary intervention (PCI), even if they have a high bleeding risk according to the HAS-BLED score.

It has previously been suggested that the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly [<65 years], Drugs/Alcohol concomitantly) score may be used to assess bleeding risk in patients with AF. However, until now, it has not been tested in those undergoing PCI.

Gregory Lip (University of Birmingham, UK) and colleagues found that of the 590 AF patients undergoing PCI in their study with a CHA₂DS₂-VASC of more than 1 (indicating anticoagulation is required), 420 (71%) had a high risk for bleeding, as indicated by a HAS-BLED score of 3 or more.

Of the whole cohort, 56% received anticoagulation at discharge. These patients had a significantly lower mortality rate, at 9.3% versus 20.1%, than those who did not receive it (p<0.01).

They also had a lower rate of major adverse cardiac events (MACE; defined as death, acute myocardial infarction, or target vessel failure) than those who did not receive oral anticoagulation at discharge, at 13.0% versus 26.4% (p<0.01).

The two groups of patients had a similar rate of major adverse events (MACE, major bleeding, or thromboembolism). However, anticoagulated AF patients had a significantly higher major bleeding rate than those who were not anticoagulated, at 11.8% versus 4.0% (p<0.01).

Multivariate analysis revealed that chronic renal failure and the use of drug-eluting stents were significant predictors for major bleeding (p<0.04). Oral anticoagulation was associated with an 80% reduced risk for mortality (p<0.01).

The authors say their findings show that the HAS-BLED score as well as the more conventionally used CHA₂DS₂-VASC score can be used to stratify risk for mortality and cardiac events in AF patients who undergo PCI.

"Management decisions in these high-risk patients should be individualized (eg, using both CHA₂DS₂-VASC and HAS-BLED scores as per guidelines) with the need for careful clinical review and regular follow-up," they comment in Circulation: Cardiovascular Interventions.

"A randomized trial is warranted to study this complex population."

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