CardioSource WorldNews | Page 24

CLINICAL

NEWS JOURNAL WRAP
published April 4 in the Lancet.
Using the 14,537-patient ARISTOTLE trial (apixaban vs. warfarin
in AF), Ziad Hijazi, MD, MPH, and
colleagues developed an internally validated biomarker-based risk score for
major bleeding. The score was then externally validated using the 8,468-patient RE-LY trial (dabigatran vs.
warfarin in AF). All major bleeding
events were centrally adjudicated and
the predictive values of biomarkers
and clinical variables were assessed
using Cox regression models.
The most important biomarker
predictors for major bleeding were
growth differentiation factor-15
(GDF-15), high-sensitivity cardiac troponin T (cTnT-hs), and hemoglobin.
Additionally, age and a prior history
of bleeding were also important predictors of major bleeding events. The
ABC-bleeding score (age, biomarkers
[GDF-15, cTnT-hs, and hemoglobin],
and clinical history [prior bleeding])
demonstrated a higher c-index than
the conventional HAS-BLED and newer ORBIT scores for major bleeding
(0.68; 95% confidence interval [CI],
0.66-0.70 vs. 0.61; 95% CI, 0.59-0.63
vs. 0.65; 95% CI, 0.62-0.67, respectively) in the derivation cohort. A
higher c-index was also found for the
ABC-bleeding score (0.71; 95% CI,
0.68-0.73) in the external validation
cohort as compared to the HAS-BLED
(0.62; 95% CI, 0.59-0.64) and ORBIT
(0.68; 95% CI, 0.65-0.70) bleeding
risk scores.
The authors concluded that the
use of a novel bleeding risk score
that incorporates biomarker data
performed better than the HAS-BLED
and ORBIT scores, and should be
used for decision support on anticoagulation treatment for patients with
AF.
The strongest predictors of major
bleeding in the cohort were biomarkers reflecting anemia and cardiovascular and renal dysfunction as well as
older age and a history of bleeding.
“The availability of more independent risk indicators of the risk of
bleeding and the risk of stroke will be
important steps forward to improve
decision making on treatment with
anticoagulants in patients with AF,”
the authors write.
Hijazi Z, Oldgren J, Lindbäck J, et al. Lancet.
2016;doi:10.1016/S0140-6736(16)007418.

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CardioSource WorldNews

based on indications in which the
benefits of imaging are uncertain,
with many being inappropriate, according to findings published April 18
in JAMA: Internal Medicine. The study
also found that many patients do
not live long enough to benefit from
revascularization.