Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital, is joined by Gregory Lip, MD., University of Liverpool, and Elaine Y. Wan, MD, FHRS Columbia University, Cardiology to discuss the limitations of current clinical decision tools for assessing bleeding risk in individuals with atrial fibrillation (AF) taking direct-acting oral anticoagulants (DOACs). Conducted as a secondary analysis of the RE-LY trial and validated in multiple cohorts, the study introduces the DOAC Score as a personalized risk assessment tool. The DOAC Score incorporates various covariates such as age, creatinine clearance, underweight status, medical history, and medication use to estimate the comparative risk for major bleeding. The risk prediction model demonstrated robust performance, outperforming the HAS-BLED score in terms of predictive accuracy. Internal and external validation in diverse cohorts, including the GARFIELD-AF registry, COMBINE-AF pooled clinical trial cohort, and administrative databases, confirmed the score's reliability in stratifying bleeding risk among individuals on different DOACs. The DOAC Score represents a significant advancement in tailoring risk assessments for bleeding in AF patients receiving DOAC therapy, contributing to more informed clinical decision-making. 

https://www.hrsonline.org/education/TheLead https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064556

Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose.

Contributor Disclosure(s): G. Lip: Honoraria, Speaking, and Consulting: Bristol-Myers Squibb, Pfizer, Inc., Daiichi  E. Wan: Honoraria, Speaking, and Consulting: Medtronic, National Institutes for Health, Sanofi, Boston Scientific, Research: Zoll Medical Corp.

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