Publication: A retrospective study on the association of has-bled score with risk of gastrointestinal bleeding among patients on warfarin in Hospital Universiti Sains Malaysia
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Date
2023
Authors
Kamarulzaman, Nurshafira
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Abstract
Background: Warfarin is an oral vitamin K antagonist anticoagulant used for antiphospholipid syndrome, prosthetic valve replacement, stroke prevention in atrial fibrillation and treatment for thromboembolism. It has been widely used worldwide, especially in developing countries, because of its low cost and availability compared to other novel oral anticoagulants. Despite its valuable benefits, complications such as major bleeding, particularly gastrointestinal bleeding (GIB), are essential to prevent early. The HAS-BLED score is used as a bleeding assessment tool in patients before receiving warfarin, and significant risk factors contributing to GIB can be identified and closely monitored. However, the incidence and risk factors for GIB in patients who receive warfarin are not well documented in Malaysia. Objectives: This study aims to evaluate the effectiveness of the HAS-BLED score in predicting GIB events in patients taking warfarin at Hospital USM. Material and Methods: In this retrospective study, the data of patients receiving warfarin treatment and undergoing follow-up at Hospital USM between January 2017 and December 2021 were retrieved. The patients were categorized into a high-risk group (HAS-BLED score ≥ 3) and a non-high-risk group (HAS-BLED score ≤ 2). The association between the HAS-BLED score and the occurrence of GIB was determined using simple logistic regression followed by multiple logistic regression. Result: A total of 138 patients who received warfarin at HUSM were included in this study and the proportion of GIB was 25 patients (18.1%). The number of patients with GIB within and after six months of warfarin therapy was 16 and 9, respectively. 24 patients (96.0%) who were from the high-risk group (HAS-BLED score ≥3) had GIB and only one patient from the non-high-risk group (HAS-BLED score ≤2) had a GIB event. The outcome of this study denoted a significant association between the HAS-BLED score and GIB (P<0.001). Six significant risk factors associated with GIB were identified, including abnormal renal function, liver function, stroke, bleeding tendency, labile INR, and age (P<0.05). Conclusion: The HAS-BLED score adequately stratifies or predicts GIB events among patients who received warfarin in Hospital USM. A high HAS-BLED score (≥3) was associated with increased GIB events among patients on warfarin therapy. Further studies can help to establish the diagnostic performance of the HAS-BLED score in predicting GIB among patients on warfarin.
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Keywords
Gastrointestinal bleeding , International Normalized Ratio