{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:42:48Z","timestamp":1790700168291,"version":"4.1.0"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,9,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Patients with atrial fibrillation (AF) treated with oral anticoagulants may be exposed to an increased risk of bleeding events. The HAS\u2010BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INRs, Elderly, Drugs or alcohol) score is a simple, well\u2010established, clinical bleeding\u2010risk prediction score. Recently, a new algorithm\u2010based score was proposed, the GARFIELD\u2010AF (Global Anticoagulant in the Field\u2013AF) bleeding score. We compared HAS\u2010BLED and GARFIELD\u2010AF scores in predicting adjudicated bleeding events in a clinical trial cohort of patients with AF taking anticoagulants, in the first external comparative validation of both scores.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We analyzed patients from the SPORTIF (Stroke Prevention Using an Oral Thrombin Inhibitor in Patients With AF) III and V trials. All patients assigned to the warfarin arm with information to calculate the scores were considered. Outcomes were major, major\/clinically relevant nonmajor, and any bleeding. A total of 3550 warfarin\u2010treated patients were available for analysis. Of these patients, 2519 (71.0%) had a HAS\u2010BLED score \u22653, whereas based on GARFIELD\u2010AF median value, 2056 (57.9%) were categorized as \u201chigh score.\u201d Both HAS\u2010BLED and GARFIELD\u2010AF C\u2010indexes showed modest predictive value (C\u2010index [95% confidence interval] for major bleeding, 0.58 [0.56\u20130.60] and 0.56 [0.54\u20130.57], respectively); however, GARFIELD\u2010AF was not predictive of any bleeding. The GARFIELD\u2010AF bleeding score had a significantly lower sensitivity and a negative reclassification for any bleeding compared with HAS\u2010BLED, assessed by integrated discrimination improvement and net reclassification improvement (both\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\u00a0HAS\u2010BLED showed a 5% net benefit for any bleeding occurrence.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">The algorithm\u2010based GARFIELD\u2010AF bleeding score did not show any significant improvement in major and major\/clinically relevant nonmajor prediction compared with the simple HAS\u2010BLED score. For clinical usefulness in prediction of any bleeding, the HAS\u2010BLED score showed a significant net benefit compared with the GARFIELD\u2010AF.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.009766","type":"journal-article","created":{"date-parts":[[2018,9,16]],"date-time":"2018-09-16T15:02:17Z","timestamp":1537110137000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Predicting Bleeding Events in Anticoagulated Patients With Atrial Fibrillation: A Comparison Between the HAS\u2010BLED and GARFIELD\u2010AF Bleeding Scores"],"prefix":"10.1161","volume":"7","author":[{"given":"Marco","family":"Proietti","sequence":"first","affiliation":[{"name":"Institute of Cardiovascular Sciences University of Birmingham Birmingham United Kingdom"},{"name":"Department of Neuroscience IRCCS\u2014Istituto di Ricerche Farmacologiche Mario Negri Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Miguel","family":"Rivera\u2010Caravaca","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hospital Cl\u00ednico Universitario Virgen de la Arrixaca Instituto Murciano de Investigaci\u00f3n Biosanitaria (IMIB\u2010Arrixaca), CIBER\u2010CV Murcia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Asunci\u00f3n","family":"Esteve\u2010Pastor","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hospital Cl\u00ednico Universitario Virgen de la Arrixaca Instituto Murciano de Investigaci\u00f3n Biosanitaria (IMIB\u2010Arrixaca), CIBER\u2010CV Murcia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio Francesco","family":"Romiti","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Medical Specialties Sapienza\u2010University of Rome Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franc\u00edsco","family":"Marin","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hospital Cl\u00ednico Universitario Virgen de la Arrixaca Instituto Murciano de Investigaci\u00f3n Biosanitaria (IMIB\u2010Arrixaca), CIBER\u2010CV Murcia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Sciences University of Birmingham Birmingham United Kingdom"},{"name":"Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart &amp; Chest Hospital Liverpool UK"},{"name":"Aalborg Thrombosis Research Unit Department of Clinical Medicine Aalborg University Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1160\/TH16-11-0876"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.004517"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1160\/TH11-10-0690"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw210"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1636534"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-0134"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.22436"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/jth.13386"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2017.11.025"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2017.09.009"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1160\/TH17-10-0710"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2017.06.058"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-017157"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(03)00325-9"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14841-6"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.6.690"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq278"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2929"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X06295361"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6947-8-53"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1160\/TH16-10-0757"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.1.41"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2013.12.014"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2014.07.002"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.09.944"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2017.02.015"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.006703"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.006391"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.03.053"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-0608"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.111.967000"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1160\/TH11-12-0827"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV8I6A105"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2011.04378.x"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2015.10.001"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1038\/srep24376"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.06.019"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-017-11683-2"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.112.972869"},{"key":"e_1_3_2_42_2","first-page":"3265","article-title":"Assessing bleeding risk in atrial fibrillation with the HAS\u2010BLED and ORBIT scores: clinical application requires focus on the reversible bleeding risk factors","volume":"36","author":"Lip GYH","year":"2015","unstructured":"Lip GYH, Lane DA. Assessing bleeding risk in atrial fibrillation with the HAS\u2010BLED and ORBIT scores: clinical application requires focus on the reversible bleeding risk factors. 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