{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T17:26:44Z","timestamp":1793467604835,"version":"4.5.0"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The comparative performance of the DOAC score versus established bleeding risk scores in patients with atrial fibrillation (AF) receiving direct oral anticoagulants (DOACs) remains uncertain. This meta\u2010analysis evaluated the predictive ability of the DOAC score compared with HAS\u2010BLED and ORBIT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed and Embase were systematically searched to identify studies assessing the predictive performance of the DOAC score in AF patients treated with DOACs. Pooled C\u2010indices were calculated to compare discrimination. Reclassification metrics (net reclassification improvement [NRI], integrated discrimination improvement [IDI]), calibration analyses, and decision curve analyses (DCA) were synthesized qualitatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine studies comprising 12 cohorts were included (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200989\u2009688). The DOAC score demonstrated significantly superior discrimination for major bleeding compared with HAS\u2010BLED (C\u2010index 0.68 vs. 0.63). No significant differences were observed for intracranial hemorrhage, gastrointestinal bleeding, or clinically relevant non\u2010major bleeding, nor in comparisons with ORBIT. Reclassification analyses showed heterogeneous findings, with several studies reporting no incremental benefit of the DOAC score, although one large cohort demonstrated improved NRI and IDI over HAS\u2010BLED. Calibration analyses revealed good performance across scores, though both HAS\u2010BLED and DOAC tended to overestimate bleeding risk in high\u2010risk groups. DCA suggested variable but occasionally greater net benefit of the DOAC score at clinically relevant risk thresholds.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The DOAC score provides modest but statistically significant improvement in predicting major bleeding compared with HAS\u2010BLED, with comparable performance to ORBIT. However, reclassification, calibration, and clinical utility vary across settings, underscoring the need for further prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.70315","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T11:25:32Z","timestamp":1777289132000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["DOAC Score Versus HAS\u2010BLED and ORBIT for Predicting Bleeding Events in Atrial Fibrillation on Direct Oral Anticoagulants"],"prefix":"10.1002","volume":"49","author":[{"given":"Yanfei","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine The First People's Hospital of Chenzhou, The First Affiliated Hospital of Xiangnan University Xiangnan University Chenzhou Hunan People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1280-0158","authenticated-orcid":false,"given":"Wengen","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Cardiology The First Affiliated Hospital of Sun Yat\u2010Sen University Guangzhou People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qunfeng","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine The First People's Hospital of Chenzhou, The First Affiliated Hospital of Xiangnan University Xiangnan University Chenzhou Hunan People's Republic of 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