{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:50:02Z","timestamp":1782967802170,"version":"3.54.5"},"reference-count":31,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,8,9]],"date-time":"2022-08-09T00:00:00Z","timestamp":1660003200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In patients with atrial fibrillation (AF) treated with direct oral anticoagulants (DOAC), bleeding risk scores provide only modest discrimination for major or intracranial bleeding. However, warfarin experience may impact HAS\u2010BLED\u00a0 (Hypertension, Abnormal renal\/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (&gt;65 years), Drugs\/alcohol concomitantly) score performance in patients evaluated for DOACs, as HAS\u2010BLED was derived and validated in warfarin cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective cohort study of patients prescribed DOAC for AF in the Veterans Health Administration between 2010 and 2017. We determined modified HAS\u2010BLED score discrimination and calibration for bleeding, for patients treated with DOAC, stratified by prior warfarin exposure. We also determined the association between\u00a0DOAC\u2013warfarin\u2010na\u00efve status to bleeding (nonintracranial and intracranial) with DOAC\u2013warfarin\u2010experienced patients as reference.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The DOAC analysis cohort included 100,\u2009492 patients with AF (age [mean\u2009\u00b1\u2009SD]: 72.9\u2009\u00b1\u20099.6 years; 1.7% female; 90.1% White), of which 26,\u2009760 patients (26.6%) and 73,\u2009732 patients (73.4%) were warfarin experienced or na\u00efve, respectively. HAS\u2010BLED discrimination for bleeds was modest for patients treated with DOAC, regardless of prior warfarin experience (concordance\u00a0statistics: 0.53\u20130.59). For DOAC\u2013warfarin\u2010na\u00efve patients, as compared to DOAC\u2013warfarin\u2010experienced patients, adjusted risk of intracranial bleeding was lower, while risk of nonintracranial bleeding was higher <jats:styled-content>(<\/jats:styled-content><jats:italic>intracranial bleeding<\/jats:italic> propensity adjusted with inverse probability of treatment weights [IPTWs]: hazard ratio [HR]: 0.86, 95% confidence interval [CI]: 0.78\u20130.95, <jats:italic>p<\/jats:italic>\u2009=\u2009.0040) (<jats:italic>nonintracranial bleeding<\/jats:italic> propensity adjusted with IPTW: HR: 1.15, 95% CI: 1.11\u20131.19, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients\u2019 modified HAS\u2010BLED score at the time of DOAC initiation, regardless of prior warfarin use, provided only modest discrimination for intracranial and nonintracranial bleeds. These data argue against maintaining DOAC eligible patients on warfarin therapy regardless of modified HAS\u2010BLED score.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.23887","type":"journal-article","created":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T05:45:10Z","timestamp":1660110310000},"page":"960-969","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Atrial fibrillation bleeding risk and prediction while treated with direct oral anticoagulants in warfarin\u2010na\u00efve or warfarin\u2010experienced patients"],"prefix":"10.1002","volume":"45","author":[{"given":"Alexander C.","family":"Perino","sequence":"first","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System Palo Alto California USA"},{"name":"Department of Medicine Stanford University Stanford California USA"},{"name":"Center for Digital Health Stanford University Stanford California 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Health Care System Palo Alto California USA"},{"name":"Center for Digital Health Stanford University Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System Palo Alto California USA"},{"name":"Department of Medicine Stanford University Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8025-0904","authenticated-orcid":false,"given":"Mintu P.","family":"Turakhia","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System Palo Alto California USA"},{"name":"Department of Medicine Stanford University Stanford California USA"},{"name":"Center for Digital Health Stanford University Stanford California 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