{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T04:03:41Z","timestamp":1793246621883,"version":"4.5.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100019718","name":"Boehringer Ingelheim GmbH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019718","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Major bleeding remains a major barrier to optimal anticoagulation in patients with atrial fibrillation (AF). We aimed to develop and externally validate a weighted score that balances clinical usability and predictive performance for 1-year major bleeding prediction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Using prospective multinational Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation (GLORIA-AF) Phase II\/III data, we developed the GLORIA-AF Bleeding Weighted Risk Score using least absolute shrinkage and selection operator-penalized regression with stability selection, coefficient rescaling, and internal validation. The score was externally evaluated in EURObservational Research Programme Atrial Fibrillation and EURObservational Research Programme Atrial Fibrillation registries. Discrimination, calibration, and clinical benefit were assessed using concordance index (C-index), observed-to-expected ratio, calibration plot, and decision-curve analysis and compared with HAS-BLED, the unweighted GLORIA-AF score, and the full multivariable Cox model. Among 20 250 eligible derivation cohort patients [69.9 (10.3) years; 9092 female (44.9%)], 317 (1.6%) had major bleeding during 1-year follow-up. The derived score ranges from 0 to 22, with the highest weight (5) assigned to age &amp;gt;65 years, followed by abnormal kidney function (3). The derived score achieved a C-index of 0.688 (95% CI, 0.660\u20130.717), outperforming HAS-BLED (C-index, 0.631; 95% CI, 0.604\u20130.658; P &amp;lt; 0.001), while preserving discrimination comparable to full multivariable regression (C-index, 0.690; 95% CI, 0.661\u20130.719; P = 0.084). Calibration was good (observed-to-expected ratio, 0.996) and DCA showed a greater net benefit than HAS-BLED across 1\u20133% thresholds. Among 9752 external validation patients, 148 (1.5%) had major bleeding. The derived score achieved a C-index of 0.674 (95% CI, 0.643\u20130.705; P &amp;lt; 0.001), with better discrimination, calibration, and clinical benefit than HAS-BLED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The GLORIA-AF Bleeding Score showed modestly higher discrimination than HAS-BLED for 1-year major bleeding prediction while retaining clinical interpretability and usability. External validation in independent European and Asia-Pacific registries further supports its transportability beyond the derivation population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag447","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:27:53Z","timestamp":1787570873000},"source":"Crossref","is-referenced-by-count":2,"title":["Development and external validation of the GLORIA-AF Bleeding Weighted Risk Score for patients with atrial fibrillation"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7250-7759","authenticated-orcid":false,"given":"Yifan","family":"Xie","sequence":"first","affiliation":[{"name":"Institute of Life Course and Medical Sciences, University of Liverpool , William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX ,","place":["UK"]},{"name":"Department of Computer Science, Faculty of Environment, Science and Economy, University of Exeter , Exeter ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0772-2575","authenticated-orcid":false,"given":"Wenhui","family":"Li","sequence":"additional","affiliation":[{"name":"Institute of Life Course and Medical Sciences, University of Liverpool , William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX ,","place":["UK"]},{"name":"Department of Computer Science, Faculty of Environment, Science and Economy, University of Exeter , Exeter ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7344-2174","authenticated-orcid":false,"given":"Yanda","family":"Meng","sequence":"additional","affiliation":[{"name":"Bioengineering Program, Division of Biomedical Sciences, King Abdullah University of Science and Technology , Thuwal ,","place":["Saudi Arabia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7740-8843","authenticated-orcid":false,"given":"Tianjin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Computer Science, Faculty of Environment, Science and Economy, University of Exeter , Exeter ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalin","family":"Zheng","sequence":"additional","affiliation":[{"name":"Institute of Life Course and Medical Sciences, University of Liverpool , William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1423-5348","authenticated-orcid":false,"given":"Menno V","family":"Huisman","sequence":"additional","affiliation":[{"name":"Department of Thrombosis and Hemostasis, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9820-4815","authenticated-orcid":false,"given":"Giuseppe","family":"Boriani","sequence":"additional","affiliation":[{"name":"Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6587-3094","authenticated-orcid":false,"given":"Tze-Fan","family":"Chao","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Taipei Veterans General Hospital , No. 201, Sec. 2, Shih-Pai Road, Taipei 112201 ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y H","family":"Lip","sequence":"additional","affiliation":[{"name":"Institute of Life Course and Medical Sciences, University of Liverpool , William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX ,","place":["UK"]},{"name":"Department of Clinical Medicine, Aalborg University , Aalborg ,","place":["Denmark"]},{"name":"Medical University of Bialystok , Bialystok ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,29]]},"reference":[{"key":"2026090119161992600_zwag447-B1","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euae195","article-title":"Global burden of atrial fibrillation\/atrial flutter and its attributable risk factors from 1990 to 2021","volume":"26","author":"Cheng","year":"2024","journal-title":"Europace"},{"key":"2026090119161992600_zwag447-B2","article-title":"Atrial fibrillation: stroke prevention","volume":"37","author":"Chao","year":"2024","journal-title":"Lancet Reg Health 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