Arrhythmias & electrophysiologyCohort study
Performance of direct oral anticoagulant (DOAC) and HAS-BLED scores in predicting major bleeding in Asian patients with non-valvular atrial fibrillation receiving direct oral anticoagulants
- Retrospective cohort study
- multicentre
- prognostic score comparison
Authors' conclusion
The 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.
Study context
- Population
- Asian patients with non-valvular atrial fibrillation (AF) receiving DOACs, multicentre database in Taiwan (June 2012-December 2021)
- Participants
- 21,142 patients
- Exposure
- DOAC score vs HAS-BLED score for predicting major bleeding
- Outcome
- Major bleeding events (ISTH criteria)
- Follow-up
- 1-year follow-up
Main finding
As reported in the abstract
Major bleeding: discrimination (AUC)
| Group | AUC |
|---|---|
| DOAC score | 0.670 (95% CI: 0.650-0.689) |
| HAS-BLED | 0.642 (0.623-0.663) |
- DOAC score vs HAS-BLED: P < 0.001
- Major bleeding events
- 681 patients (3.66%/year)
- Both scores associated with significant risk of major bleeding, only modest predictive performance
- AUC < 0.7
Observational data: associations, not effects.
Further findings
Intracranial haemorrhage
- Intracranial haemorrhage events
- 82(0.43%/year)
Calibration
- Both scores well calibrated for low to intermediate risk; both overestimate major bleeding risk in high risk categories
Subgroups
- Superiority of DOAC score primarily driven by elderly patients (≥75 years) and gastrointestinal bleeding prediction
Original publication
Performance of DOAC and HAS-BLED scores in predicting major bleeding in Asian patients with non-valvular atrial fibrillation receiving direct oral anticoagulants. Europace. Published 3 October 2025. doi:10.1093/europace/euaf251
Summarised from the published abstract; every number is checked against it