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Comparisons of HATCH, HAVOC and CHA<sub>2<\/sub>DS<sub>2<\/sub>-VASc scores for all-cause mortality prediction in atrial fibrillation: A real-world evidence study. <i>Postgrad Med J<\/i> 2023; 99: 326\u2013332, doi:10.1136\/postgradmedj-2021-141147.","DOI":"10.1136\/postgradmedj-2021-141147"},{"key":"7","doi-asserted-by":"crossref","unstructured":"7. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: The Euro Heart Survey. <i>Chest<\/i> 2010; 138: 1093\u20131100.","DOI":"10.1378\/chest.10-0134"},{"key":"8","doi-asserted-by":"crossref","unstructured":"8. Yasaka M, Minematsu K, Yamaguchi T. 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