Evidence map›Paper›PMID 41043006›Full record

ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2025

Performance of DOAC and HAS-BLED scores in predicting major bleeding in Asian patients with non-valvular atrial fibrillation receiving direct oral anticoagulants.

Yi-Hsin Chan, Yi-Wei Kao, Shao-Wei Chen, Tze-Fan Chao

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Yi-Hsin ChanThe Cardiovascular Department, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.ORCID 0000-0002-1406-8503
Yi-Wei KaoDepartment of Applied Statistics and Information Science, Ming Chuan University, Taoyuan City, Taiwan.ORCID 0000-0002-7891-9514
Shao-Wei ChenDivision of Thoracic and Cardiovascular Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan.ORCID 0000-0003-1674-1295
Tze-Fan ChaoDivision of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, 112062,Taipei, Taiwan.ORCID 0000-0002-6587-3094

Funding

Chang Gung Memorial HospitalMinistry of Science and Technology CMRPG3N1031Ministry of Science and Technology CMRPG3N1032
6 · The paper itself

Abstract

aimsThe direct oral anticoagulant (DOAC) score was recently developed to predict bleeding risk in patients with atrial fibrillation (AF) receiving oral anticoagulants. However, limited data show inconsistent results comparing its performance to the conventional HAS-BLED score in Asian populations with non-valvular AF receiving DOACs. METHODS AND

resultsWe enrolled 21 142 patients with non-valvular AF receiving DOACs from a multicentre database in Taiwan (June 2012-December 2021). The primary endpoint was major bleeding events. Major bleeding events were defined according to the ISTH criteria. Areas under receiver operating characteristic curves (AUCs) were calculated for each score, with differences assessed using DeLong test. A total of 21 142 AF patients (mean age 75.9 ± 11.0 years; 41% female) treated with DOAC were included in the analysis. Major bleeding events occurred in 681 patients in 1-year follow-up (3.66%/year). There were 82(0.43%/year) intracranial haemorrhage event occurred. Both the DOAC and HAS-BLED scores are associated with a significant risk of major bleeding event, with only modest predictive performance (AUC < 0.7). The DOAC score showed a slightly but statistically significantly higher AUC compared with the HAS-BLED score [AUC: 0.670 (95% CI: 0.650-0.689) vs. 0.642 (0.623-0.663); P < 0.001]. Results from several reclassification analyses favoured the DOAC score. Both the two scores showed a good calibration for the low to intermediate risk categories, while the two bleeding risk scores both overestimate the risk of major bleeding risk for the high risk categories. Subgroup analyses indicated that the superiority of DOAC score over HAS-BLED score is primarily driven by elderly patients (≥75 years) and prediction in risk of gastrointestinal bleeding.

conclusionThe DOAC score, which employs a more granular scoring system compared to the HAS-BLED score, may enable finer bleeding risk discrimination among Asian patients with non-valvular AF receiving DOAC therapy.

Indexed as

Atrial FibrillationFactor Xa InhibitorsHemorrhageStrokeAdministration, OralAgedAged, 80 and overAnticoagulantsEast Asian PeopleFemaleHumansMaleMiddle AgedPredictive Value of TestsRisk AssessmentRisk FactorsAnticoagulantsFactor Xa InhibitorsBleeding risk assessmentDOACHAS-BLEDNon-valvular atrial fibrillation

Identifiers

PMID41043006
PMCPMC12578370

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.